06/03/2020

Billing CPT 97760 with an E&M

Can code 97760 (Orthotic Fitting and Training / ea. 15 min) be used on the same day as an evaluation and management code ?( 99213 for example) I will give a clinical scenario: A patient presents for follow up to have Custom Foot Orthoses dispensed. The patient's diagnosis is Plantar Fasciitis (M72.2). The patient asks to discuss the risks vs the benefits of surgical management. The patient is also given a prescription for Physical Therapy and is taught stretching exercises by the podiatrist. The patient also discusses the current analgesic medication, being used to treat the the Plantar Fasciitis. The medication is not helping so the doctor gives the patient a new Rx for a different NSAID. Can the code 97760 be used for the dispensing of the DME and 99213 for the evaluation and management? If so, should modifier 25 be appended to the 99213?

Most insurance carriers consider fitting/training inclusive of the DME dispensed and do not reimburse the procedure separately.  While there is no issue attempting to bill the CPT 97760, it most likely will deny as bundled.