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 You have to use the modifier 59 with re-eval to get it to go through. Heidi Harmon Billing Manager Lee's Summit, MO Re-Evaluation denials We have been receiving denials from Medicare Part B for all re-evaluation codes T and PT. These are being denied based on the code alone, no supporting ocumentation being reviewed or considered. A general message along the lines f " Medicare guildines are not being appropriately followed.. " accompanies the enials. We use the re-eval codes when there is a condition change or new diagnosis that ffects the plan of care currently in place. I'm not sure how to proceed from here. Any input is greatly appreciated. ristie Leverenz, PT nited Therapy Services, Inc 411 112th S. lue Grass, Iowa 52726 63-343-4735 mlev@... ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and our location or else your message will not be approved to send to the full roup. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our rofessions. PTManager is not available to support POPTS-model practices. The escription of PTManager group includes the following: PTManager believes in and supports Therapist-owned Therapy Practices ONLY " essages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, OTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. TManager blog: http://ptmanager.posterous.com/ ahoo! Groups Links Individual Email | Traditional http://docs.yahoo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2011 Report Share Posted July 11, 2011 Kristie Just spoke with your husband to clarify something in your post. If you bill a Re-eval code with any other procedure, Medicare considers it concurrent therapy and it bumps up against their CCI (Correct Coding Initiative) edits. In order to get paid, you will need to tack on a -59 modifier which indicates you performed the Re-Eval at a distinctly different time as the other procedures performed on that day. Hope this helps! Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/892-0142 Visit our website at: www.rehabmgmt.com 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...
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