Health Information Management

Should you override that outpatient therapy NCCI edit?

Briefings on APCs, April 1, 2010

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Such therapies are considered edited pairs and are not billable on the same date of service unless the -59 modifier (distinct procedural service) is appended properly. “One of the uses for this modifier is that it indicates that the procedure or service was distinct or independent from other services performed on the same day,” says Mary R. Daulong, PT, CHC, owner and president of Business & Clinical Management Services, Inc., in Spring, TX.

However, therapists may have a legitimate reason for providing both services. Sometimes a patient has more than one diagnosis, such as a shoulder problem and a knee problem. The therapist may address the shoulder problem with a land-based exercise, whereas the knee problem may be susceptible to impact or post-surgery stressors and thus require the buoyancy of a water-based program. 

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