Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95

Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Cardiac Rehab Modifier Question

Chris Posted Tue 03rd of September, 2019 14:32:16 PM
Initial question is, as I understand it S9472 is no longer a billable code and has been replaced with the below CPT and HCPCS codes. With cardiac rehab, the services would be rendered by a PT or PTA while a physician is supervising. I just want to clarify and confirm that the GP modifier can be used with the CPT and HCPCS codes while billing with the supervising physician as the rendering since the modifier should signal that a PT, PTA, or exercise physiologist rendered the service. CPT 93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) 93798 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) HCPCS G0422 Intensive cardiac rehabilitation, with or without continuous ECG monitoring with exercise, per session G0423 Intensive cardiac rehabilitation, with or without continuous ECG monitoring without exercise, per session S9472 Cardiac rehabilitation program, non-physician provider, per diem
SuperCoder Answered Wed 04th of September, 2019 04:51:12 AM

Hi Chris,

 

Modifier GP should be appended to codes specific to physical therapy services only. Modifier GP should not be appended to provided set of codes (93797, 93798, G0422, G0423, S9472). For his service, physical therapist would bill GP modifier with physical therapy specific evaluation codes (97161-97163).

 

Hope provided information would be helpful.

 

Thanks!   

 

Chris Posted Wed 04th of September, 2019 11:15:49 AM
So, regardless of who is leading the cardiac rehab. As long as the supervising cardiologist is on site, simply bill the cardiac rehab code without the GP Modifier, e.g. G0422, G0423? It seemed as if adding the GP would signify to the insurance carrier that someone other than the cardiologist led the session since cardiac rehab would be billed under the supervising MD NPI.
SuperCoder Answered Thu 05th of September, 2019 03:52:13 AM

Hi Chris,

 

Thank you for the follow up. Yes, bill cardiac rehab codes without GP modifier for the reasons mentioned earlier. Ensure supervising cordiologist should be in the vicinity and available for help on ASAP basis as and when required.

 

Thanks!  

Related Topics