Re: When is it an eval or re-eval?

[Guest guest]

Depends on their insurance really. It would technically be a new evaluation

because of the time that has lapsed, but some insurance companies (i.e., BCBS)

will only allow one (1) initial evaluation per calendar year - everything else

is considered a re-evaluation. WC will only cover one (1) initial evaluation

per injury.

Amy Stelly

Clinic Coordinator (Office Manager)

LeBlanc, Chamberlain and Physical Therapy Services

4027 I-49 South Service Road

Opelousas, Louisiana 70570

Telephone: Facsimile:

________________________________

From: PTManager [PTManager ] On Behalf Of AOD

Physical Therapy [aodpt03@...]

Sent: Wednesday, August 06, 2008 2:40 PM

To: ptmanager

Subject: When is it an eval or re-eval?

Dear Group,

Just wondering if you have a patient with a condition that can reoccur or be

exacerbated when do you consider it a new evaluation or a re-evaluation? For

example, a patient with a mensical tear or rotator cuff tear was discharged

after treatment with a HEP and little to no pain and they return to your clinic

1-2 months later with an exacerbation. No changes have taken place, the

therapist after examining the patient is using the same ICD-9 code as before.

Is this an eval or re-eval charge? What timeframe does one use to determine

this?

Thank you in advance for your response.

Sincerely,

Jill Sedmak, PT, MSPT, ATC

[Guest guest]

In the past year, we have sponsored two of Rick Gawenda's audio conferences

for our PT/OT clients. If you have not attended one of these live audio

conferences, do so. It is inexpensive, extremely informative, usually no longer

than 90 minutes, and the last 30 minutes he takes questions form the audience.

It is not simply a matter of insurance coverage, it is a matter of what

constitutes an " initial " evaluation versus what constitutes a " re-evaluation. "

It is also a matter of knowing proper coding and when to append a 59 distinct

procedure modifier when billing an insurance company for a second IE or a

re-evaluation.

Rick, please weigh in on this subject matter.

D. Cavitt, President

Medical Legal Alliance, LLC

In a message dated 8/7/2008 9:43:52 A.M. Central Daylight Time,

Amy.Stelly@... writes:

Depends on their insurance really. It would technically be a new evaluation

because of the time that has lapsed, but some insurance companies (i.e., BCBS)

will only allow one (1) initial evaluation per calendar year - everything

else is considered a re-evaluation. WC will only cover one (1) initial

evaluation per injury.

Amy Stelly

Clinic Coordinator (Office Manager)

LeBlanc, Chamberlain and Physical Therapy Services

4027 I-49 South Service Road

Opelousas, Louisiana 70570

Telephone: Facsimile:

________________________________

From: _PTManager@yahoogrouPTMana_ (mailto:PTManager )

[_PTManager@yahoogrouPTMana_ (mailto:PTManager ) ] On Behalf Of

AOD

Physical Therapy [_aodpt03@..._ (mailto:aodpt03@...) ]

Sent: Wednesday, August 06, 2008 2:40 PM

To: _ptmanager@yahoogrouptmana_ (mailto:ptmanager )

Subject: When is it an eval or re-eval?

Dear Group,

Just wondering if you have a patient with a condition that can reoccur or be

exacerbated when do you consider it a new evaluation or a re-evaluation? For

example, a patient with a mensical tear or rotator cuff tear was discharged

after treatment with a HEP and little to no pain and they return to your

clinic 1-2 months later with an exacerbation. No changes have taken place, the

therapist after examining the patient is using the same ICD-9 code as before.

Is this an eval or re-eval charge? What timeframe does one use to determine

this?

Thank you in advance for your response.

Sincerely,

Jill Sedmak, PT, MSPT, ATC

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