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5 Things Physical Therapists Need to Know About Modifier 59

Today’s blog post comes from Geoff Elledge, WebPT Billing Specialist. Thanks, Geoff! 

One of the primary reasons medical providers depend on certified coders is for their ability to maximize practice revenues. To do so, certified coders must understand how and when to use modifiers—and there are a lot—from the common sides of treatment, like right (RT) and left (LT), to the more challenging modifier 59. 

The CPT Manual defines modifier 59 as the following:

“Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures [and/or] services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.”

Got that? Yeah, we know. It’s a bit dense and doesn’t seem the most relatable. But that’s because modifier 59 is intended mainly for surgical procedures, so the definition leans a great deal that way.

So how does modifier 59 come into play in the therapy setting? If you’re providing two wholly separate and distinct services during the same treatment period, it might be modifier 59 time! The National Correct Coding Initiative (NCCI) has identified procedures that therapists commonly perform together and labeled these “edit pairs.” Thus, if you bill a CPT code that is linked to one of these pairs, you’ll receive payment for only one of the codes. It’s therefore your responsibility as the therapist to determine if you’re providing linked services or wholly separate services. This will determine whether modifier 59 is appropriate.

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Does Cutting Expenses Really Grow Your Practice?

In this third video of a three-part series, PT and entrepreneurial consultant Jamey Schrier explains why looking at your practice’s staff as an investment—rather than a cost—is the key to achieving business growth and financial success.

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Using Your Past as a Crystal Ball

In this second video of a three-part series, PT and entrepreneurial consultant Jamey Schrier explains why looking into your clinic’s past is the key to driving future success.

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3 Quick Wins for Your Online Marketing Strategy

Starting a clinic in a new city—with new referral sources and limited networks—can be very challenging. But with the right online marketing strategy, you can expedite the process. In fact, over the last three months, I’ve been able to grow my patient base by using old school word-of-mouth marketing and establishing an online presence in the local community. There are many ways to use the power of the Internet to market to patients and referring providers, and in this post, I’ll provide one tip for each area of digital marketing—blogging, social media, and email—that has produced results for me.

1. Write Blogs Patients Actually Want to Read

More and more, patients are using search engines like Google to find physical therapy services. Direct access has played a major role in this change, and patients are taking it upon themselves to do the research and find the right physical therapists for their needs. Almost all physical therapy websites have pages dedicated to highlighting their teams, their areas of specialization, what services they offer, and where to find them. So, how can you make your clinic stand out online? Writing engaging blog posts is an excellent first step toward standing out from the crowd.

Most physical therapists, including myself, aren’t Hemingway. For that reason, writing a blog post may seem like a daunting task. So, break it down to something simpler: If you had to write one blog post this month, what would it be about? How do you know your audience is looking for that type of information? To get a better look at your prospective patients’ online behavior, you can use Google Webmasters—a free Google that helps you monitor and maintain your site’s presence in Google search results—in conjunction with Google Analytics, another free service that helps you monitor website activity. Google Webmaster allows you to see what keywords led your visitors to your website. In my case, I saw that I had a couple of users who were looking for ways to prevent skiing injuries. Based on this piece of data, I organized my blog calendar to prioritize posts about skiing and snowboarding-related topics above all else. I then shared my blog posts across all my social media channels—including Google+, Twitter, and Facebook—and, with help from Google Analytics, I’ve been able to track how many new web visitors I garnered as a result of the posts as well as which social media channels were the most effective in driving traffic to those posts. Making time for writing can be difficult—especially when you have a good volume of patient visits—but it’s an important activity that will help to attract new patients.

2. Ask Patients to Share Their Experiences

In addition to using search engines to look for physical therapy services, patients are consulting review sites like Yelp to find clinics and read reviews from current and former patients. In this post, I won’t go into the nitty-gritty details of how Yelp works (for more information, read this post), but a general rule of thumb is having a healthy number of highly-rated reviews—especially compared to your competition—from Yelp users who have a strong history of reviewing on Yelp will increase your clinic’s ranking on this particularly influential directory.

We love hearing how we have positively impacted our patients’ lives, and—as simple as this may sound—asking our patients for reviews has been our best way of getting them. As the old saying goes, ask and you shall receive. We educate our patients on how testimonials play a huge role in:

  • helping future patients decide where to seek medical care and
  • determining where doctors refer their patients.

We ask our customers for feedback online via an automated survey and I follow-up with our patients a week later if I don’t hear back. In addition to asking customers for feedback online, we always ask for feedback after every visit. That way, we can make sure they are getting the service they want.

As a physical therapists, we love helping people get back to functioning and living pain free, but if we’re also passionate about enlisting our patients as advocates for building our practices—via testimonials, reviews, and social media participation—we can grow our practices and thus, help even more people.

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