All payers depend on physical therapists to use medical judgment to provide patients with correct services and to submit claims for payment with correct information. By now billers and physical therapists should be familiar the four new PT codes for 2017 if not, you will discover a lot of denials and rejections of claims. The new codes replace the unclear “PT evaluation” with a more specific evaluation type. Including the length of time the evaluation. Here are the new codes: 97161-PT evaluation low complexity, 20 min; 97162-PT evaluation moderate complexity, 30 min; 97163-PT evaluation high complexity, 45 min; 91764-PT re-evaluation est. plan care. Make sure to use GP (physical Therapy) modifier for billing Medicare. This applies to the four new PT codes, indicating services delivered to the outpatient physical therapy program. This article is a good source of information on how the physical therapist bill the insurance properly without denial or rejection. When submitting a claim for services, you are validating that you earned the payment for the services rendered and you are in conformity with all the billing requirements. Also, remember that Medicare rules regarding therapy caps also for 2017. An increase of $20 yearly in Cap – 2017 $1,980 for PTand speech-language pathology combined. When billing under the exemption, modifier KX must be used. But remember when you use Modifier KX you are certifying that the service provided reasonably and there is a documentation of medical necessity in the PT’s medical records. Therefore, it is important to know the type of coverage and payment policies of Commercial Insurers, Medicare, Medicaid, workers compensation and automobile liability. We should remember that Ignorance is not a defense. It is a violation of the law if you knew that you submitted a claim that is false and attempting to obtain payment from the government or private payer.
I choose this particular topic because it is informative and helps physical therapist on how to bill the insurers properly using the new PT codes and modifier (for Medicare) and to avoid denials/rejections of claims. Might lead to loss of payments for services provided to patients. This topic is important also because with the new PT codes are more specific when submitting claims. With claims accepted the PT practice will continue providing medical service to their patients.