Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 We have been receiving denials from Medicare Part B for all re-evaluation codes OT and PT. These are being denied based on the code alone, no supporting documentation being reviewed or considered. A general message along the lines of " Medicare guildines are not being appropriately followed.. " accompanies the denials. We use the re-eval codes when there is a condition change or new diagnosis that effects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. Kristie Leverenz, PT United Therapy Services, Inc 7411 112th S. Blue Grass, Iowa 52726 kmlev@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 Make sure you have a 59 modifier on the re-eval code. If you didn't have it attached, correct and resubmit and they should get paid. Kathi G Welch PT Re-Evaluation denials We have been receiving denials from Medicare Part B for all re-evaluation codes OT and PT. These are being denied based on the code alone, no supporting documentation being reviewed or considered. A general message along the lines of " Medicare guildines are not being appropriately followed.. " accompanies the denials. We use the re-eval codes when there is a condition change or new diagnosis that effects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. Kristie Leverenz, PT United Therapy Services, Inc 7411 112th S. Blue Grass, Iowa 52726 kmlev@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 Make sure you have a 59 modifier on the re-eval code. If you didn't have it attached, correct and resubmit and they should get paid. Kathi G Welch PT Re-Evaluation denials We have been receiving denials from Medicare Part B for all re-evaluation codes OT and PT. These are being denied based on the code alone, no supporting documentation being reviewed or considered. A general message along the lines of " Medicare guildines are not being appropriately followed.. " accompanies the denials. We use the re-eval codes when there is a condition change or new diagnosis that effects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. Kristie Leverenz, PT United Therapy Services, Inc 7411 112th S. Blue Grass, Iowa 52726 kmlev@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 I know this may sound basic, but are you using the -59 modifier on the re-eval code? Also, your LCD would show if the number of re-evals allowed or re-eval guidelines has recently changed for your Medicare carrier. Ruesewald Therapy Billing PO Box 880 , Lake Dallas , TX 75065 fax The documents accompanying this email transmission contain confidential information that is legally protected and privileged. The information is intended for the use of the recipient named above. If you have received this email in error, please notify us immediately by telephone () to arrange for return of the document to us. You are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this transmission is strictly prohibited. From: PTManager [mailto:PTManager ] On Behalf Of leverenzm Sent: Monday, July 11, 2011 12:21 PM To: PTManager Subject: Re-Evaluation denials We have been receiving denials from Medicare Part B for all re-evaluation codes OT and PT. These are being denied based on the code alone, no supporting documentation being reviewed or considered. A general message along the lines of " Medicare guildines are not being appropriately followed.. " accompanies the denials. We use the re-eval codes when there is a condition change or new diagnosis that effects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. Kristie Leverenz, PT United Therapy Services, Inc 7411 112th S. Blue Grass, Iowa 52726 kmlev@... <mailto:kmlev%40msn.com> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 Hi Kristie, Are you putting the 59 modifier on the codes, if not that is why they are being denied. Re-eval codes are codes against every other CPT codes in the CCI edits. ine ine M. o, PT Owner Encompass Consulting & Education, LLC 8114 NW 100th Terrace, Tamarac, FL 33321-1259 We work hard to make sure you are " getting it right from the start " . Visit our website at <http://www.encompassmedicare.com/> www.encompassmedicare.com and see what we can do for you. While there sign up for our free e-mail Newsletter " Medicare News and Rules for Therapists " . We specialize in consulting services, seminars and customized education services to providers of Medicare rehabilitation therapy and related services. NOTICE: This communication is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this communication is not the intended recipient or the employee or agent responsible for delivering the communication, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to this email. From: PTManager [mailto:PTManager ] On Behalf Of leverenzm Sent: Monday, July 11, 2011 1:21 PM To: PTManager Subject: Re-Evaluation denials We have been receiving denials from Medicare Part B for all re-evaluation codes OT and PT. These are being denied based on the code alone, no supporting documentation being reviewed or considered. A general message along the lines of " Medicare guildines are not being appropriately followed.. " accompanies the denials. We use the re-eval codes when there is a condition change or new diagnosis that effects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. Kristie Leverenz, PT United Therapy Services, Inc 7411 112th S. Blue Grass, Iowa 52726 kmlev@... <mailto:kmlev%40msn.com> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 A 59 modifier should be place on claim. This may help you get paid on the 97002 Code. Crystal Gallegos Office Manager Buena Vida Physical Therapy Phone: Fax Quote Link to comment Share on other sites More sharing options...
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