There is more to this question than can really be addressed by e-mail alone,
but there are a few critical points that I think need to be made.
1-97150 is an untimed code, and therefore can only be billed once per date
2-As this group well knows, CPT is copyrighted, and these codes cannot be
defined on the fly, and at our whim.
3-While CMS has its' own extensive coverage, coding and documentation
requirements, other payers are increasingly following them. We know this
because we are working with some of these payers on doing so.
4-For better or worse, these types of claims involve more than a claim form.
The backup documentation is frankly even more important than the 1500.
I can tell you first-hand that the reviews of documentation we are
performing seldom support the billing we are seeing. Providers have no one
to blame but themselves for this problem.
Ken Mailly, PT
Mailly & Inglett Consulting, LLC
Tel. 973 692-0033
Fax 973 633-9557
68 Seneca Trail
Wayne, NJ, 07470
Bridging the Gap!
From: AmLee Billing Services [mailto:amlee_billing@...
Sent: Tuesday, March 01, 2005 11:44 PM
To: CRN-L; PMOM; Amba
Subject: [CRN-L] WC Billing Help- Denials
What is the best way to respond to WC denials of care based on the
limitations of the Medicare Guidelines. More and more I am seeing
the IC denying rehab over 45 minutes based on the Medicare Treatment
Guidelines that state only 30 to 45 minutes are needed.
What is the best way to handle this when filing for reconsideration's? I
wanted to get other opinions before I went with what I feel is the best
solution. My problem is the IC denying any more than 3 units on therapeutic
exercises 97110 or 97150. Medicare is suppose to be a fee guideline and not
a treatment guideline, but the IC is using the guidelines as a treatment
Amie Pennington-White CCHRS;CMHRS;CMRS;CPC;MA;CNA;RNA
CEO AmLee Billing Services
Office: (817) 676-2221
Fax: (817) 788-2175
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