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ROM EXAM WITH E/M

Sylvia Posted Thu 19th of April, 2012 21:21:07 PM

WHICH CODE TO USE FOR E/M WTH ROM
I HAVE MY PROVIDER WHO PERFORM AN ROM ON PATIENT WITH SEVERE PAIN BUT CCI WON'T ALLOW ME TO BILL BOTH

SuperCoder Answered Thu 19th of April, 2012 21:29:43 PM

Routine muscle and range of motion testing is a component of a physical examination within the E/M service.
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With E/M:
Muscle, range of motion, and physical performance testing are normally done as part of the physical examination and would be included in the Evaluation and Management (E/M) service. These services are usually not billable over and above the E/M code (CPT #99201-99205 and #99211-99215).
However, under certain circumstances, these tests may be reported independently. This would require the testing of muscle strengths, ranges of motion, and/or physical performance, the recording of each individual value, the comparison of these to a standardized grading scale (whether verbal or numerical), and the creation of a formal, written, and signed report of the specific findings. If there is sufficient cjustification, and all the above conditions are met, then these codes could be billed as“separately identifiable” procedures and a –25 modifier would need to be appendedto the E/M code.
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With CMT:
These codes may be billed along with CMT (CPT #98940-98943) as long as the required criteria have been met. Again, use of the Manual Muscle Testing codes requires testing of muscle strengths, the comparison of these values by the examiner to a standardized grading scale (whether verbal or numerical), and the creation of a formal, written, signed report of the findings listing specific values for the muscles tested. Use of the Range of Motion Measurement codes requires identification of the specified body areas, specific measurement values, and preparation of a formal, written, signed report of the findings. These codes, when used in conjunction with CMT, would require the –59 modifier to be appended.
Manual Muscle and ROM Testing with Physical Performance Testing:
Neither Manual Muscle Testing (95831-95834) nor Range of Motion Measurement (95851-95852) should be separately reported from Physical Performance Testing/Measurement (97750), as both services are included as part of Physical Performance Testing procedures.

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