Can CPT codes 97116 and 97530 be billed together?

What happens if I bill 97530 (therapeutic activities) and 97161, 97162, or 97163 (physical therapy evaluations) together on same day for same patient? This is at the heart of the recent edit. Under the new rules, the use of both codes is prohibited, and there’s no modifier that you can use to bypass the denial.

Can CPT 97530 and 97535 be billed together?

The CPT code combinations 97530 (Therapeutic Activity) and 97535 (ADL) requires Modifier 59 to enable the codes to be billed individually on the same day. Note: CPT code 97535 is usually reimbursed after a rate higher than TA, TE, NMR & MT.

Can you bill manual therapy and therapeutic activity together?

Alternate Codes Alternatively, you can avoid the edit entirely by delivering interventions other than therapeutic activities (97530) when performing manual therapy (97150) during the same patient visit. However, you cannot simply perform a therapeutic activity and bill it as a therapeutic exercise.

What is procedure code 97116?

97116 CPT Code Description: Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing). The clinician instructs the patient in specific activities that will facilitate ambulation and stair climbing with or without an assistive device.

What does CPT code 97530 mean?

CPT code 97530 requires “use of dynamic activities to improve functional performance. Examples of such activities include lifting, pushing, pulling, reaching, throwing, etc.” Billing this code also requires direct, one on one contact, billed in 15-minute increments.

Does CPT 97530 require a modifier?

97530-CO x 2 The occupational therapist performed one 15-minute unit alone, so no modifier is needed.

How do I bill a 97530?

What is the difference between 97530 and 97140?

Code 97530 is mutually exclusive with code 97140 but a modifier is allowed in order to differentiate between the services provided. Code 97140 is mutually exclusive with code 97530 and cannot be billed using any modifier.

Is 97116 a timed code?

For example, a patient under a PT plan of care receives skilled treatment consisting of 20 minutes of therapeutic exercise (CPT 97110) and 20 minutes of gait training (CPT 97116). The total “Timed Code Treatment Minutes” documented will be 40 minutes.

What can be billed under 97530?

What is procedure CPT code 97116?

What is the best practice for CPT code 97530?

The best practice is to determine what functional outcome is expected from the task. Your documentation needs to include the specific focus of the functional task and/or activity and should be clearly identified in the goals for 97530. CPT code 97110 is a therapeutic procedure, on one or more areas, each lasting 15 minutes.

What is the purpose of procedure 97113?

97113 (aquatic therapy) – This procedure uses the therapeutic properties of water (e.g., buoyancy, resistance). The procedure may be reasonable and medically necessary for a loss or restriction of joint motion, strength, mobility or function that has resulted from a specific disease or injury.

What does the ICD 10 code 97542 mean?

97542 (Wheelchair Mobility) and 97530 (Therapeutic Activity) 97542 (Wheelchair Mobility) and 97110 (Therapeutic Exercise) 97530 (Therapeutic Activity) and 97542 (Wheelchair Mobility)