Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 We have been experiencing denials from Medicare for physical therapy due to incorrect diagnosis codes. For example, we just received a denial for a patient that we treated who came to us with a diagnosis of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord Injury, and were denied. Does anyone have any suggestions on how to find acceptable diagnosis codes for Medicare? Thanks for your suggestions, Maddox, PT, MPH Director of Rehabilitation Ukiah Valley Medical Center 275 Hospital Drive Ukiah, CA 95482 maddoxrg@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 The medical diagnosis is the admitting/discharge diagnosis from the hospital, and the treatment diagnosis is the consequence of the medical diagnosis for which the patient is receiving skilled physical therapy, which could be muscular weakness 728.87, or difficulty in walking 719.7, or abnormality of gait 781.2, or lack of coordination, or abnormal posture, etc., all related to the therapeutic goal and rehab potential to achieve improved bed mobility only, or positioning with wheelchair mobility, or transfers, or/ and ambulation, etc. Edilia Gualdron, DPT > > We have been experiencing denials from Medicare for physical therapy > due to incorrect diagnosis codes. For example, we just received a > denial for a patient that we treated who came to us with a diagnosis > of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord > Injury, and were denied. Does anyone have any suggestions on how to > find acceptable diagnosis codes for Medicare? > Thanks for your suggestions, > > Maddox, PT, MPH > Director of Rehabilitation > Ukiah Valley Medical Center > 275 Hospital Drive > Ukiah, CA 95482 > > maddoxrg@... <mailto:maddoxrg%40ah.org> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 The medical diagnosis is the admitting/discharge diagnosis from the hospital, and the treatment diagnosis is the consequence of the medical diagnosis for which the patient is receiving skilled physical therapy, which could be muscular weakness 728.87, or difficulty in walking 719.7, or abnormality of gait 781.2, or lack of coordination, or abnormal posture, etc., all related to the therapeutic goal and rehab potential to achieve improved bed mobility only, or positioning with wheelchair mobility, or transfers, or/ and ambulation, etc. Edilia Gualdron, DPT > > We have been experiencing denials from Medicare for physical therapy > due to incorrect diagnosis codes. For example, we just received a > denial for a patient that we treated who came to us with a diagnosis > of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord > Injury, and were denied. Does anyone have any suggestions on how to > find acceptable diagnosis codes for Medicare? > Thanks for your suggestions, > > Maddox, PT, MPH > Director of Rehabilitation > Ukiah Valley Medical Center > 275 Hospital Drive > Ukiah, CA 95482 > > maddoxrg@... <mailto:maddoxrg%40ah.org> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 15, 2012 Report Share Posted May 15, 2012 The medical diagnosis is the admitting/discharge diagnosis from the hospital, and the treatment diagnosis is the consequence of the medical diagnosis for which the patient is receiving skilled physical therapy, which could be muscular weakness 728.87, or difficulty in walking 719.7, or abnormality of gait 781.2, or lack of coordination, or abnormal posture, etc., all related to the therapeutic goal and rehab potential to achieve improved bed mobility only, or positioning with wheelchair mobility, or transfers, or/ and ambulation, etc. Edilia Gualdron, DPT > > We have been experiencing denials from Medicare for physical therapy > due to incorrect diagnosis codes. For example, we just received a > denial for a patient that we treated who came to us with a diagnosis > of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord > Injury, and were denied. Does anyone have any suggestions on how to > find acceptable diagnosis codes for Medicare? > Thanks for your suggestions, > > Maddox, PT, MPH > Director of Rehabilitation > Ukiah Valley Medical Center > 275 Hospital Drive > Ukiah, CA 95482 > > maddoxrg@... <mailto:maddoxrg%40ah.org> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2012 Report Share Posted May 16, 2012 I recommend you read the LCD that Palmetto has for PT, OT, and SLP. You will see that 806.4 is not a payable ICD-9 for outpatient PT services in their LCD. Here is the link. You may need to copy and paste the link in your web browser. I will also be doing a webinar on ICD-9 coding as well as other subjects on June 19th. You can obtain more information from my website under " Current News " . http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=171 & \ ContrVer=1 & CntrctrSelected=171*1 & name=Palmetto+GBA+%2801101,+MAC+-+Part+A%29 & s=6\ & bc=AggAAAAAAAAA & #ResultsAnchor Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Subject: Medicare Billing codes To: PTManager Date: Tuesday, May 15, 2012, 7:00 PM Â We have been experiencing denials from Medicare for physical therapy due to incorrect diagnosis codes. For example, we just received a denial for a patient that we treated who came to us with a diagnosis of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord Injury, and were denied. Does anyone have any suggestions on how to find acceptable diagnosis codes for Medicare? Thanks for your suggestions, Maddox, PT, MPH Director of Rehabilitation Ukiah Valley Medical Center 275 Hospital Drive Ukiah, CA 95482 maddoxrg@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2012 Report Share Posted May 16, 2012 I recommend you read the LCD that Palmetto has for PT, OT, and SLP. You will see that 806.4 is not a payable ICD-9 for outpatient PT services in their LCD. Here is the link. You may need to copy and paste the link in your web browser. I will also be doing a webinar on ICD-9 coding as well as other subjects on June 19th. You can obtain more information from my website under " Current News " . http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=171 & \ ContrVer=1 & CntrctrSelected=171*1 & name=Palmetto+GBA+%2801101,+MAC+-+Part+A%29 & s=6\ & bc=AggAAAAAAAAA & #ResultsAnchor Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Subject: Medicare Billing codes To: PTManager Date: Tuesday, May 15, 2012, 7:00 PM Â We have been experiencing denials from Medicare for physical therapy due to incorrect diagnosis codes. For example, we just received a denial for a patient that we treated who came to us with a diagnosis of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord Injury, and were denied. Does anyone have any suggestions on how to find acceptable diagnosis codes for Medicare? Thanks for your suggestions, Maddox, PT, MPH Director of Rehabilitation Ukiah Valley Medical Center 275 Hospital Drive Ukiah, CA 95482 maddoxrg@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 16, 2012 Report Share Posted May 16, 2012 I recommend you read the LCD that Palmetto has for PT, OT, and SLP. You will see that 806.4 is not a payable ICD-9 for outpatient PT services in their LCD. Here is the link. You may need to copy and paste the link in your web browser. I will also be doing a webinar on ICD-9 coding as well as other subjects on June 19th. You can obtain more information from my website under " Current News " . http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=171 & \ ContrVer=1 & CntrctrSelected=171*1 & name=Palmetto+GBA+%2801101,+MAC+-+Part+A%29 & s=6\ & bc=AggAAAAAAAAA & #ResultsAnchor Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Subject: Medicare Billing codes To: PTManager Date: Tuesday, May 15, 2012, 7:00 PM Â We have been experiencing denials from Medicare for physical therapy due to incorrect diagnosis codes. For example, we just received a denial for a patient that we treated who came to us with a diagnosis of spinal cord injury. We used ICD9 code 806.4- Closed Fx/Spinal Cord Injury, and were denied. Does anyone have any suggestions on how to find acceptable diagnosis codes for Medicare? Thanks for your suggestions, Maddox, PT, MPH Director of Rehabilitation Ukiah Valley Medical Center 275 Hospital Drive Ukiah, CA 95482 maddoxrg@... Quote Link to comment Share on other sites More sharing options...
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