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Physical Performance Test 97750 in Physician Office

Nathan Posted Fri 03rd of January, 2020 10:13:30 AM
Hello, I work in an orthopedic surgeon's office and we conduct comprehensive physical performance tests with some of our patients who exhibit heightened fall risk (TUG, Single Limb Stance, etc). Our program has a report generated and the physician interprets the result. It then gets filed into the EHR. Our question is, what is the appropriate modifier to use with this code (it says either GP or GO because it is an "always therapy code") and if we need to re-test the patient at a later date, how long should we wait to not be excessive?
SuperCoder Answered Mon 06th of January, 2020 04:08:18 AM
Hi,
 

 

CPT 97750 will be coded with GP modifier if service is furnished under physical therapy plan of care. CPT 97750 will be coded with GO modifier if service is furnished under occupational therapy plan of care.

The billing guidelines say you may use CPT 97750 preferably once a month, though some plans and necessity may require every two weeks. However, generally, providers perform the test thrice during the treatment period; once in the beginning, to establish a baseline of assessment data, then, during middle of the treatment to find out the improvement, and lastly before discharge, to evaluate the post treatment status.

 

 

Note: CPT codes 97750 (Physical performance test or measurement), 97755 (Assistive technology assessment), and 97763 (Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes) are not separately reportable for the same date of service with a physical therapy evaluation/re-evaluation CPT code (e.g., 97161-97164) or occupational therapy evaluation/re-evaluation CPT code (e.g., 97165-97168) when the two services are performed by a single practitioner or two practitioners of the same specialty. If the two services are performed by two different practitioners of different specialties, the two services may be reported using an NCCI PTP-associated modifier. For example, if a physical therapist performs one service and an occupational therapist performs the other service, the two services may be reported separately. However, if a physical therapist performs one service and a different physical therapist performs the other service, the two services are not separately reportable.

 

Please also check below links:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3814CP.pdf

 

https://www.supercoder.com/coding-newsletters/my-neurology-coding-alert/reader-question-calculate-97750-coding-in-15-minute-increments-147014-article

 

Thanks

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