Health Information Management

Q/A: Unbundling therapy services

APCs Insider, February 26, 2010

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Q: If a physical performance test is conducted (97750, physical performance test or measurement [e.g., musculoskeletal, functional capacity], with written report, each 15 minutes) on the same day as an initial evaluation (97001), can we use modifier -59 (distinct procedural service) to bypass the edits to get paid for both services?
 
 A: No. In this scenario, you cannot report a modifier. According to the NCCI edits, 97750 is a component of 97001. The NCCI modifier key is 0 –meaning no modifier will override the edit. You can bill 97001 and include the cost associated with 97750 as part of the charge for the single line item, or you can report a separate line item under an appropriate revenue code without a CPT code to reflect the 97750 cost/charge.



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