CPT Code for Physical Therapy Evaluation and the Functional Limitation G Codes for Medicare Claims
Mar21

CPT Code for Physical Therapy Evaluation and the Functional Limitation G Codes for Medicare Claims

CPT Code for Physical Therapy Evaluation is CPT Code 97001 Remember your CPT Code for Physical Therapy Evaluation 97001 must only be billed once per condition, per episode and per problem with 1 unit. It is a Faced-to-Faced Encounter, non-time based and no matter how long you spent time with the patient, you will still bill one unit for CPT Code for Physical Therapy Evaluation. I wrote this article about the PT Evaluation code plus the Functional Limitation G Codes that you must submit with your claims for Medicare. This article is based on Medicare Processing Manual Revised 2859 Issued 01-17-2014, Effective 01-01-2014 and with an Implementation Date of 01-31-2014. As of this writing, the guideline is still the same. Functional Reporting ( see reference – Rev. 2859, Issued: 01-17-14, Effective: 01-01-14, Implementation: 01-31-14) Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) amended Section 1833(g) of the Act to require a claims-based data collection system for outpatient therapy services, including Physical Therapy (PT), Occupational Therapy (OT) and Speech-Language Pathology (SLP) Therapy services. WHY? I think that this is going to be a big help in research and data gathering. Because what it does is that, the system will collect and gather data on beneficiary function during the course of therapy services in order to better understand beneficiary conditions, outcomes, and expenditures. These Functional G Codes are being reported using 42 NON-Payable functional G-codes and seven severity-complexity modifiers on claims for PT, OT, and SLP services. Meaning, they are only used for data gathering. And that is functional reporting on one functional limitation at a time is required periodically throughout an entire PT, OT, or SLP therapy episode of care. The nonpayable G-codes and severity modifiers are used for information gathering purposes about the patient or beneficiary’s functional status at the outset of the therapy service episode of care, including the status of projected goals, at specified points during treatment, and at the time of discharge. I honestly like these functional limitations reporting! These G-codes, along with the associated modifiers, are required at specified intervals on all claims for outpatient therapy services, not just those over the cap. Therapy Billing Services covered with this new rule Date of Service on or after July 1, 2013, that does not have the required functional G-code and modifier information will be returned or rejected. Date of Service prior are in testing phase. So as I am writing this post, rest assured that anything after July 1, 2013 must have your G-codes appended. I make sure my CPT Code for Physical Therapy Evaluation must be reported with G-codes on...

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How to Bill for Spinal Cord Stimulation Trial Placement Code CPT 63650 Permanent Placement
May29

How to Bill for Spinal Cord Stimulation Trial Placement Code CPT 63650 Permanent Placement

How to Bill for Spinal Cord Stimulation Trial Placement Code CPT 63650 Effective January 01, 2014 we have some changes on how to bill for the CPT code for the Percutaneous Lead Trial. ** We are still using the same code CPT 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) for the Percutaneous Lead Trial ** Medicare will no longer reimburse separately for the L8680 Implantable neurostimulator electrode, each. They are now bundled with the CPT 63650 (Percutaneous implantation of neurostimulator electrode array, epidural) service as part of the “Office-based”, Non-Facility reimbursement. ** For the Multiple Procedure of the same code, up to 4 units may be paid by Medicare at 50% Reduction Medicare allowed amount Let’s review the coding here: CPT Code must be billed with the number of units/leads. So if your physician did 2 leads; bill it like this: CPT 63650 x 1 unit CPT 63650-51 x 1 unit ** Per the CCI Edits, your Fluoro is bundled with the CPT 63650 CPT Code 63650 EXCLUDES  Analysis and programming of neurostimulator pulse generator (95970-95975) Additional CPT Programming Codes (if performed by the physician) CPT Code 95971 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming CPT Code 95972 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming 95973 (DELETED 01/01/2016) – Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure) – Code 95973 has been deleted effective 01/01/2016 ICD 10 Medical Necessity (some on the list below): G89.29 Other chronic pain G89.3 Neoplasm related pain (acute) (chronic) G89.4 Chronic pain syndrome G90.50 Complex regional pain syndrome I, unspecified G90.511 Complex regional pain syndrome I of right upper limb G90.512 Complex regional pain syndrome I of left upper limb G90.513 Complex regional pain syndrome I of upper limb, bilateral G90.519 Complex regional pain syndrome I of unspecified upper limb G90.521 Complex regional pain syndrome I of right lower limb...

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