CPT Neurology billing

[Aida Pena]

Hello everyone,

I was wondering if anyone could help me with billing neurology, I recently started working for. I have advise them of some cpt code they were billing wrong. They have been billing cpt code with modifer GP, for example cpt code: 97032GP, 97112GP, 97110GP, and 97530GP. I advise them that this cpt code require a PT to do the procedure and we did not have a PT doing the procedure we were no longer going to use this codes.

Now i am looking for cpt codes that could replace this procedures codes that would not require a PT to do the procedure.

Please advise.

 

[Carolyn Heath]

Could the practice get in trouble for billing wrong codes? Did they know the codes were wrong or were they just unaware of it?

 

[Luna]

Was the patient's visit in the outpatient setting part of a Physical Therapy Plan of Care?

Who performed these direct (one-n-one) services?

 

[Carolyn Heath]

It said that the practice does not have a PT doing procedures. What she is looking for are CPT codes that would not require a PT to do the procedures. This is a neurology practice, not a physical therapy practice.

 

[Teresa K.]

The only way these codes can be billed by a MD or DO practice on a CMS-1500 claim form is if the Doctor has a licensed PT working for them. I don't see how the office is being reimbursed by payors. If you look in your CPT 2013 book, you will a description above the CPT 97110 code that states "physician or other qualified health professional (i.e. therapist)" What is going to happen is the insurance, if they have paid these claims, or going to do take backs on all of the claims.

 

[Luna]

It said that the practice does not have a PT doing procedures. What she is looking for are CPT codes that would not require a PT to do the procedures. This is a neurology practice, not a physical therapy practice.

I understood what she said about a PT not the one providing the service and that it is a neurology she is billing for. When I read in the CPT manual for those codes though and it said "physician or other qualified health professional (i.e. therapist)" it just made me curious, who in their clinic did perform the therapeutic services being billed. I was just curious, in a learning kind of way. Like trying to picture, in the real world, how this note is being applied. So, I was just asking some partial questions, to gather more info to satisfy my own curiosity.

I had wondered, if a clinic had a PT, but another qualified healthcare professional was providing the services under the supervision of the PT, then is it OK to use those codes? (That was just one of the things I was curious about,.) And, if a clinic did not include a PT at all, then who was performing the therapeutic services? And, well, just a bunch of questions running through my mind. (It was not fair of me to use this thread though to ask those questions.)

I didn't know that a neurology practice wouldn't/ or couldn't include therapy services though, because there is such a thing as neurology physical therapy. And, so with my error in understanding, I apparently asked a stupid question. Which, when you're learning is going to happen a lot.

@Aida Pena, I hope you find an answer to your question. My apologies though for using your thread to raise some of my own curious thoughts. Blame it on poor manners, and an over abundance of eagerness to learn. There is a time and place for everything, and sometimes, I get it mixed up.

 

[aida]

Thanks, everyone for you answers. I have made the physician aware that this cpt code can no longer be billed. I am looking for other codes that could substitute the cpt codes. I have found only cpt code 97012. I will welcome any other information.