NCCI Edits: Questions and Answers
On June 15, 2020, I published an article where I answered some of the more common questions I receive regarding the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits as they pertain to outpatient physical, occupational and speech therapy services. That article led to additional questions that I will provide answers to in this article.
Question
Does the Medicare program pay for CPT code 97750 (Physical performance test or measurement) on the same day as a physical therapy or occupational therapy evaluation or reevaluation?
Answer
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Question
Does the Medicare program pay for CPT code 97755 (Assistive technology assessment) on the same day as a physical therapy or occupational therapy evaluation or reevaluation?
Answer
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Question
Does the Medicare program pay for CPT code 97763 (Orthotic/prosthetic management/training; subsequent encounter) on the same day as a physical therapy or occupational therapy evaluation or reevaluation?
Answer
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Question
Does the Medicare program pay for CPT code 97760 (Orthotic management/training; initial encounter) on the same day as a physical therapy or occupational therapy reevaluation?
Answer
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Question
Does the Medicare program pay for CPT code 97761 (Prosthetic training; initial encounter) on the same day as a physical therapy or occupational therapy reevaluation?
Answer
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Is it correct that if a patient is seen in the emergency room that we cannot charge a PT eval that day? We can charge treatments but not an eval?
There is not one answer as it may depend on the insurance carrier and how the payment is being made to the hospital.
Sorry I wasn’t clear. I was asking about Medicare. We have had a couple of denials in our sister hospitals because of a PT eval being done in the ER. I can’t seem to find any NCCI edit that talks about this.
You would need to look at the NCCI edits and if no PTP edit for the CPT codes you are billing, then contact the insurance if you still have questions.
Good Afternoon,
We have a request from a local business to perform pre-employment assessments of their new employees ability to lift, carry, range of motion, strength. Do we need to bill the company with a CPT code or should we just bill for the service? If CPT code, would 97750 be appropriate?
Thank you.
This would fall under my consulting services. If interested, email me directly.