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The Basic Principles of Using Modifier 59 in Physical Therapy

For therapists, coding can be complicated. And it gets even more complicated when modifiers enter the picture. Modifiers are tricky things. Used wisely, they can help maximize your revenue. But used erroneously, they can wreak havoc in the form of claim denials and penalties. And if there’s one modifier that

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Physical Therapy Coding Updates
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New Physical Therapy Coding Updates for 2017

It’s time again to welcome the new year and with it, changes that will make our practices better than before. Among these changes? Physical Therapy codes.

Recently it was announced that the Physical Therapy Evaluation (97001) and Physical Therapy Re-evaluation (97002) codes have been deleted, and four new codes have been released in their place. These codes will be effective by January 1, 2017.

The new evaluation codes (97161 to 97163) center around services ranging in complexity from low to high, each with a code descriptor specifying required components. To give you an idea of each new code, some of the requirements are stated below:

Code no. 97161 – Physical therapy evaluation: low complexity, requiring the following components:

• A history with no personal factors and/or comorbidities that impact the plan of care;
• An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions;
• A clinical presentation with stable and/or uncomplicated characteristics; and
• Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome.

In this case, usually 20 minutes are spent face-to-face with the patient and/or family.

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