Rehab

BRRR coding corner

Briefings on Outpatient Rehab: Reimbursement and Regulations, December 1, 2008

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Editor’s note: Rick Gawenda, PT, director of rehabilitation services at Detroit Receiving Hospital and owner of Gawenda Seminars in Ypsilanti, MI, answered the coding questions below. Submit questions to Associate Editor Emily Beaver at ebeaver@hcpro.com.

Q. Since Palmetto took over September 2, we have been receiving denials for PT stating that diagnoses are not medically necessary. We are billing with the same diagnosis we billed to the National Heritage Insurance Company and were processed. Do you know whether Palmetto changed its local coverage determination (LCD) for PT diagnosis?

A. Palmetto GBA, in their PT and OT LCDs, linked ICD-9 codes to each individual CPT code to support the medical necessity of the interventions provided.

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