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Bundling with office visit

Nicole Posted Sun 14th of October, 2018 11:11:18 AM
I am newer to billing for a PM&R doctor. It seems when she does the 95831 and 95851 (mostly) along with several other therapeutic activities and muscle testings everything is bundled into the office visit. Is there something that I should be doing differently or coding instead of the office visit? She spends a lot of time with the patients so I just want to make sure I am billing correctly for her to obtain maximum reimbursement. Any help or guidance would be greatly appreciated.
SuperCoder Answered Mon 15th of October, 2018 04:11:32 AM

Hello Nicole,

Thank you for your question.


As per CCI edit, CPT® code 95851 is a column 2 code for CPT® code 95831; therefore, you would not be able to report both the codes on same date of service. Unfortunately, you cannot bypass these CCI bundling edits with a modifier. So, you can only report CPT® code 95831.


If your provider has done the E/M on the same date of service, then report only the E/M service, since both the CPT® codes (95831 and 95851) are column 2 codes for the E/M service codes.


Please feel free to ask any further question, if any.

Nicole Posted Mon 15th of October, 2018 08:46:25 AM
So basically everything that she does is included with the office visit? Would I be able to bill for just the 95831x4, for example, instead of the office visit?
SuperCoder Answered Tue 16th of October, 2018 02:16:42 AM

Yes, both the services are a part of evaluation and management services.


Also, you can report 4 units of CPT® code 95831; as the maximum allowable unit for this code is 5; therefore, you can report maximum 5 units of this CPT® code on the date of service.


Thank you.

Nicole Posted Wed 17th of October, 2018 18:10:57 PM
To clarify, can I bill the 95831 only instead of an office visit?
SuperCoder Answered Thu 18th of October, 2018 03:42:28 AM

Yes, you can bill CPT® code 95831; if your provider has not performed the E/M. 


Thank you.

Nicole Posted Fri 02nd of November, 2018 16:25:53 PM
It just seems like the provider is spending/doing a lot with the patient to only be able to bill an office visit when she is performing 95831/95851/97112/97530 in addition to the E/M service. Is there any websites you could give for billing guide references for PM&R billing?
SuperCoder Answered Mon 05th of November, 2018 03:00:39 AM

Hi Nicole,

Thank you for your additional query.


Since, we have answered your previously posted query and provided you with the appropriate solution as per coding guidelines; we would request you to kindly place this query in the new thread as the new codes have been added.

Post this query in the new post so that we can work upon the same.


Thank you.

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