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Functional Testing

David Posted Fri 30th of January, 2015 16:08:51 PM

In NY for a Workers' Compensation patient you must provide objective functional testing to document positive patient response. I also order functional testing as a precaution for prescribing controlled substances. I use an independent company to fulfill the objectivity requirement; they do not pay rent. The functional company sends to my office a Technologist (MD, DC, or PT) to perform the functional assessment and provides back to me a 24 page report of the findings. It takes me approximately 40 minutes to review/analyze/interpret; I then develop a treatment plan and consult the patient, which takes approximately 15 minutes.

David Posted Fri 30th of January, 2015 16:13:04 PM

In total that equates to 55 minutes of my time. What code or codes should I bill for the 55 minutes it takes me.

SuperCoder Answered Mon 02nd of February, 2015 05:08:25 AM

Functional Capacity Evaluations (FCE), are often performed on patients covered under workers compensation. Here is a link for information on FCE from the The American Occupational Therapy Association:

The CPT code 97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes if often used to report performance of a FCE with corresponding report of findings.

With that said, each state has their own workers compensation jurisdiction which sets the fee schedule rules, including codes to be used, etc. Workers compensation is not considered to be a covered entity under HIPPA and as such can create billing codes to meet their needs, i.e. codes not found in the CPT or HCPCS code set. I would recommend that the practice contact the specific state workers compensation to verify if the 97750 code is the correct code for a FCE or if the workers compensation jurisdiction uses a different code for providers to report these services.

Thanks !!

David Posted Thu 12th of February, 2015 19:17:24 PM

Thanks for the response! What about code 99358?

SuperCoder Answered Mon 16th of February, 2015 03:59:52 AM

You can not bill 99358 with 97750. Bill units of code 97750 for each 15 minutes of time spent in functional testing. Thanks !!

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