Are the CPT codes on the claim form supported by the documentation?
Review some of your own recent claims and your documentation. Try to match the CPT codes on the claim with the interventions described in your documentation. Would it make a difference if you used a different documentation format: narrative, SOAP, functional outcomes, flow sheet, or check-off format? There are advantages and disadvantages to certain documentation formats. While there is no industry standard, the table below notes comments that APTA has received from payers around the country. Are the CPT codes on the claim subject to a payer edit program? Payers, including Medicare, often have edit systems for certain code pairs that are billed on the same day of service by the same provider. Some of these code combinations are understandable if you try to look at the issue from a payer perspective, but some make no sense. For example, under Medicare’s CCI edit system, Manual Therapy, 97140, is edited as a mutually exclusive edit with Functional Activities, 97530. This edited code pair
