97597 is within the Physical Therapy Chapter of the AMA-CPT4 Coding area, yet it still retains the same type of identity as other surgical codes, which have an inherent E/M within its reimbursement formula. The ideology is thus that no payment should be made for two E/M peformed on an exising patient on the same date by the same provider.
Thus as with other surgical CPT (eg. 11042, 28285, etc.), there is a CCI edit, which precludes payment for the performance of 97597 and the perfomance of an e/m code for an existing patient.
However, there is an exception. If the E/M code is for a separately identifiable service (e.g. plantarfasciitis) and the devitalized tissue is on the hallux, then a separate E/M could be reimbursable by amending a 25 modifier to the E/M for the existing patient.
It would be advisable to have a separate note for the E/M with the appropriate history, examination and medical decision components geared to the treatment of the plantarfasciitis.
Another example could be the development of a new wound on the right foot and the debridement of an existing wound on the left.
The right foot removal of devitalized tissue could be billed as 97597 and the left with the appropriate ICD10 and 9921X-25.
Be sure the ICD10 are as site specific as possible to point out that not only are the CPT on separate sites, but so is the ICD10.
And of course as always, medical necessity for all the services performed must be clearly documented.
Thank you Dr. Kesselman for your explanation of the coding of 97597. It clarifies what we discussed over the weekend.
97597 is within the Physical Therapy Chapter of the AMA-CPT4 Coding area, yet it still retains the same type of identity as other surgical codes, which have an inherent E/M within its reimbursement formula. The ideology is thus that no payment should be made for two E/M peformed on an exising patient on the same date by the same provider.
Thus as with other surgical CPT (eg. 11042, 28285, etc.), there is a CCI edit, which precludes payment for the performance of 97597 and the perfomance of an e/m code for an existing patient.
However, there is an exception. If the E/M code is for a separately identifiable service (e.g. plantarfasciitis) and the devitalized tissue is on the hallux, then a separate E/M could be reimbursable by amending a 25 modifier to the E/M for the existing patient.
It would be advisable to have a separate note for the E/M with the appropriate history, examination and medical decision components geared to the treatment of the plantarfasciitis.
Another example could be the development of a new wound on the right foot and the debridement of an existing wound on the left.
The right foot removal of devitalized tissue could be billed as 97597 and the left with the appropriate ICD10 and 9921X-25.
Be sure the ICD10 are as site specific as possible to point out that not only are the CPT on separate sites, but so is the ICD10.
And of course as always, medical necessity for all the services performed must be clearly documented.