Coding, Modifiers and More Details.
All the guidelines for a smooth process.
Modifier 51. This modifier is appended to multiple procedures per the CPT guidelines in Appendix A of the CPT manual. It reads, “When multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). NOTE: This modifier should not be appended to designated ’add-on’ codes.” The 51 modifier is therefore applied based on this definition.
Physical Status Modifiers P1 through P6.
Per the Anesthesia Guidelines section of the CPT manual, “All anesthesia services are reported by use of the anesthesia five-digit procedure code… plus the addition of a physical status modifier.” Please make sure you use the applicable physical status modifier when billing anesthesia codes 00100 – 01999.
P1: A normal healthy patient.
P2: A patient with mild systemic disease.
P3: A patient with severe systemic disease.
P4: A patient with severe and constantly life-threatening systemic disease.
P5: A moribund patient who is not expected to survive without the operation.
P6: A patient declared brain-dead, whose organs are being removed for donor purposes.
Assistant Surgeon Services. Assistant surgeon services may only be billed when provided by an MD or DO, a physician assistant, nurse practitioner or advanced practice nurse. For assistant surgeon services provided by a physician assistant, nurse practitioner or advanced practice nurse, modifier 81 must be used in addition to the applicable CPT code. Per the American Medical Association, modifiers 80, 81 and 82 were established to reflect surgical assistant services provided by an MD.
Chiropractic, Physical Therapy and Occupational Therapy Providers. To expedite payment of physical medicine bills, here are some tips on getting your bills paid the first time:
- Submit bills with the injured worker’s complete 12-digit claim number.
- Document all exercises performed; if a flow sheet is referenced for this purpose, please attach the flow sheet.
- Document time spent per code(s) for those codes with a time element.
- Evaluations and re-evaluations should document changes and/or progress in the injured worker’s condition and/or function in addition to any other exam information.
- Supplies must be listed in the documentation.
- For chiropractic services, document all manipulations by region.
- Remember—if it isn’t documented, it isn’t done.
For a complete list of physical medicine codes allowed per the ARM, please contact anyone on the medical team and we will fax or mail you a copy.
DOLI’s 2007 Workers’ Compensation Conversion Factor for Medical Services
This information is also available at http://erd.dli.state.mt.us/wcregs/medreg.asp.
|CPT code 97750||31.81|
2007 Annual Medical Conference.
MSF’s 7th Annual Medical Conference is scheduled for November 9,2007 at Helena’s Great Northern Hotel. This year’s topic is Upper Extremity Joint Injuries: Diagnosis, Intervention and Rehabilitation. Registration details will soon be posted on MSF’s website at www.montanastatefund.com.