PPT -- 2010 UBO/UBU physical therapy-coding & billing

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  • Welcome….
  • This and the next slide are some common acronyms…definitely not an all inclusive list
  • From the PT Bulletin APTA;
    Q: How can I bill for patient education?A: The time spent providing patient education is billable time although there is not one specific CPT code for "patient education." APTA recommends that you determine your desired outcome of care related to that education. For example, if you are instructing the patient in a home program of strengthening exercises for the quadriceps, that time can be billed under 97110, therapeutic exercise. If your instruction is related to ergonomic issues in the workplace, the time can be billed under 97537, community/work reintegration training.
  • By definition, this type of training should be provided in a more real life situation…for example having a simulated kitchen, etc.
    Plinth is a base for a column, or support
  • We’ve had questions regarding a tech performing this service without a therapists plan of care. A plan of care could come as a prescription from a surgeon getting ready to do knee surgery on the patient, or it could come from the patient’s PCM…not always an official POC from a therapist.
  • This diagnosis code is usually in the top three to five most utilized every month. We perform a lot of physical therapy, which makes this so important to understand and ensure the documentation is adequate which hopefully will help the coding to be more accurate.
  • Our DoD “incident to” is not the same as CMS/Medicare rules. Our PT, OT, orthotic and Nutrition techs do have count workload so the rules for these techs are not the same as in the rest of the clinics.
  • Code 97001, Physical therapy evaluation, would be reported for the comprehensive evaluation performed at the first visit. This code is not a time-based code and should be reported once per episode, regardless of how many body parts are involved.
    CMS says (Pub 100-02) it’s okay to treat under two separate plans of care (evaluations) on the same day for different problems as long as there are two referrals or requests from different providers. There must be two separate plans of care if this occurs
    The intent of a reevaluation is to assess progress and modify or redirect future interventions. May have consecutive re-evaluations if referred for multiple problems and unable to complete in one evaluation
  • First bullet…whether timed or not, documentation must support each modality or therapeutic procedure. Group therapy documented needs to be coded as group therapy, even if patients are not performing the same exercise…example: three people attending group aquatic therapy, 1 may exercise shoulder, one knee, and one ankle.
    First indented bullet…for instance: 10 minutes of unattended e-stim, 20 minutes of aquatic exercises. Total time 40 minutes.
    Last bullet…example: 4 minutes of US and e-stim for 3
  • REMEMBER: document those therapeutic procedures (we’ve got exercises and neuromuscular education) and hot/cold packs
  • Performed by the PT only
  • Performed by the PT, not techs
    MNT = Medical Nutrition Therapy
    MTMS = Medication Therapy Management Services
  • DOCUMENT!!
  • Reimbursement, Coding, and Compliance for Physical Therapists
    The ABCs of CPT Coding
  • Documenting in the record doesn’t count for the time in the timed codes.
  • Documentation must support the service provided.
  • Total time documented performing the modality
  • Therapeutic Exercises
  • My caveat to the last bullet is that even time doesn’t have to be documented for each exercise, documentation still needs to describe what happened-exercises prescribed to patient…with total treatment time
  • The diagnosis for this would only be the condition the patient was being evaluated for.
  • For those PT clinics that are direct access, meaning the patient see the PT as a provider in a clinical setting
  • This is to say…when teaching/educating on a procedure for instance to teach the patient home exercises
  • Not sure what PM tech is??? Physical Medicine, Preventive Medicine,
  • CAPER = Comprehensive Ambulatory Professional Encounter Record
  • PPT -- 2010 UBO/UBU physical therapy-coding & billing

    1. 1. 2010 UBO/UBU Conference Health Budgets & Financial Policy Briefing: Physical Therapy Coding Date: 25 March 2010 Time: 1010–1100 1
    2. 2. 2010 UBO/UBU Conference Turning Knowledge Into Action  Objective To standardize Physical Therapy coding practices throughout the AFMS…and the rest of the MHS – PT coding issues – Confusing coding problems – Questions 2
    3. 3. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Acronyms AAROM = Active Assistive Range of Motion – ABD* = Abduction – ADD* = Adduction – ADL = Activities of Daily Living – B = Bilateral/Both – CP = Cold Pack – DTR = Deep Tendon Reflex – ext = extension – FWP = Full Weight Bearing – GT = Gait Training – HEP = Home Exercise Program – HP = Hot Pack, or MHP = Moist Hot Pack *(careful, more than one meaning) – 3
    4. 4. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Acronyms – – – – – – – – – IM* = Ice Massage LBP = Low Back Pain mob = Mobilized, Mobilization OMT = Osteopathic Manipulative Therapy POC* = Plan of Care PROM = Passive Range of Motion US = Ultra Sound, Ultrasonography VO = Verbal Order WP* = Whirlpool, Warm Pool, Wet Pack *(careful, more than one meaning) 4
    5. 5. 2010 UBO/UBU Conference Turning Knowledge Into Action • • • • • PT Coding Issues Activities of Daily Living Gait Training Osteopathic Manipulative Therapy Incident-to services (aka Technician services) When are PT evaluations/re-evaluations coded 5
    6. 6. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Activities of Daily Living – CPT® Code 97535 – Self–care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider, each 15 minutes – APTA advises - This code should be utilized when a patient is trained in the use of assistive technology to assist with mobility, seating systems and environmental control systems for use in the home environment (e.g., wheelchair mobility using a mouth control) 6
    7. 7. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues 97535 – Self Care Management Designed for ADL training/return to function at home – Cooking – Cleaning – Transfers in/out of vehicle or bathroom – Transfers out of actual hospital bed (not plinth) 7
    8. 8. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues Gait Training – CPT® Code 97116 – Watching, evaluating and training on the manner or style of walking, including rhythm and speed. Three phases of gait include the stance phase, the swing phase, and the double support phase. Crutch training included 8
    9. 9. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues Osteopathic Manipulative Treatment – CPT® codes 98925-98929 – Generally performed by Doctors of Osteopathy (DO) More appropriate in PT is CPT® code 97140 Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes – Manual therapy based on time (use units of service) as well as regions 9
    10. 10. 2010 UBO/UBU Conference Turning Knowledge Into Action    PT Coding Issues 98925-98929 OMT codes Civilian PTs do not use this code DoD guidelines allow PTs to utilize OMT when appropriate 10
    11. 11. 2010 UBO/UBU Conference Turning Knowledge Into Action   As of: PT Coding Issues V57.1 Encounter for other physical therapy – Per BDQAS – for the first quarter of FY10 utilized 85,679 times for the AF – To be assigned in primary/first listed position – Condition diagnoses coded secondarily Don’t assign V57.1 when patient presents for evaluation or re-evaluation – even when treatment starts that day – Assign referred condition in primary/first listed position 11
    12. 12. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Incident-to Services (aka Technician services) – UBO restricts use of conventional incident-to services – Appointment made to the technician if they are the provider of that therapeutic service – PT co-signatures are not required as services will not be billed although still generates RVUs for the clinic Still needs a supervising provider named on encounter (not necessarily a co-signature) – All tech services are provided under a therapist or physician documented plan of care 12
    13. 13. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues When are PT evaluations re-evaluations coded – CPT® Code 97001 evaluation – CPT® Code 97002 re-evaluation – Evaluations may occur when a new diagnosis is present to develop plan of care – Re-evaluations may occur when improvement or decline of patient condition was not anticipated to determine any changes to plan of care Patient not meeting documented long and/or short term goals 13
    14. 14. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Documentation – All methods of therapy must be documented in the patient record – Timed codes are coded per units of at least 8 minutes for one unit (see slide 17 for table) – Do not combine timed codes in separate modalities/therapeutic procedures to get one unit of service – if under 8 minutes that modality/procedure will not be coded 14
    15. 15. 2010 UBO/UBU Conference Turning Knowledge Into Action    PT Coding Issues What is the most important thing to remember about coding? If it wasn’t documented… it wasn’t done! #1 issue from the coder’s is supporting documentation 15
    16. 16. 2010 UBO/UBU Conference Turning Knowledge Into Action     PT Coding Issues Rule of 8’s Most CPT codes are based on units of time – Rule of 8’s (>8 or multiples of 15+8) • 1 unit= ≥ 8 minutes but < 23 minutes • 2 units = ≥ 23 minutes but < 38 minutes • 3 units = ≥ 38 minutes but < 53 minutes • 4 units = ≥ 53 minutes but < 68 minutes MUST validate number of units against total treatment time – If in clinic for 3 different modalities… – 97110 x 12 min; 97112 x 10 min; 97010 x 20 min – How many units can you charge??? Answer: 1 Unit of 97110: Timed 1-on-1 services = 22 min, 1 Unit of 97010: Supervised services (untimed) 16
    17. 17. PT Coding Issues 2010 UBO/UBU Conference Turning Knowledge Into Action Unit of Service 1 Greater than or equal to 08 minutes 2 23 minutes 3 38 minutes 4 53 minutes 5 68 minutes 6 83 minutes 7 98 minutes 8 113 minutes And fewer than 23 minutes total for all time-based modalities 38 minutes total for all time-based modalities 53 minutes total for all time-based modalities 68 minutes total for all time-based modalities 83 minutes total for all time-based modalities 98 minutes total for all time-based modalities 113-minutes total for all time-based modalities 128-minutes total for all time-based modalities 17
    18. 18. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Documentation – – – Physical Therapy Evaluations: Initial Evaluations (97001) include:  Therapist evaluates the patient – History – Examination – Assessment – Treatment plan Re-evaluations (97002) include:  Re-examination  Assessment of progress  Modifications to plan 18
    19. 19. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Documentation – Elements inclusive to examination or re-examination that are not coded separately  Muscle testing 95831-95834  Range of motion 95851-95852  Health and Behavior Assessment/Intervention 9615096155  Physical Performance Test 97750  Assistive Technology Assessment 97755  Orthotic/Prosthetic checkout 97762  MNT 97802-97804  MTMS 99605-99607 19
    20. 20. PT Coding Issues (Q&A) 2010 UBO/UBU Conference Turning Knowledge Into Action   Is there a limit to re-evaluation codes per pt? (If I have to do re-evaluation 3 x wk due to changes, is it alright to charge it each time?) If these changes were… ◦ Unanticipated ◦ Due to complications, additional surgeries and/or procedures, or the instability of the pt’s condition ◦ Require you to adjust your goals/treatment plan YES  If these changes were… ◦ Expected ◦ Normal progression w/ course of care ◦ Built into your POC ◦ Require minimal modification of your plan ◦ No changes to your goals NO 20
    21. 21. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues Modalities – Supervised – The “supervised modalities” (97010-97028) do not require direct one-on-one contact by the provider. Only one unit can be coded per visit, regardless of the number of body parts treated – Direct supervision – must be physically present and available in the clinic Modalities – Constant Attendance – The “constant attendance modalities” (97032-97039) require that a provider have direct one-on-one contact with the patient for the minutes represented by the code 21
    22. 22. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Therapeutic Procedures (97110-97546) – Therapist required to have direct (one-on-one) patient contact – Constant attendance required unless group therapy (97150) – Personal supervision requires that the provider is in the same room of the patient during the entire procedure and in the immediate vicinity of the patient. 22
    23. 23. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues (Q&A) T or F: We code what our patients do during their treatment session. FALSE – Technicians and therapists code what THEY do in the clinic…NOT what their PATIENTS do in the clinic. – Remember…the following are necessary in order to code for workload/reimbursement  REASONABLE & MEDICALLY NECESSARY  ADEQUATELY DOCUMENTED  Rendered by a QUALIFIED PROFESSIONAL  SKILLED services provided under a PLAN of CARE 23
    24. 24. PT Coding Issues (Q&A) 2010 UBO/UBU Conference Turning Knowledge Into Action  How can I bill for the time one patient is exercising in the gym doing exercises on the equipment? If, while exercising, the PT or PTA is monitoring the pt’s pulse and BP and instructions are given related to target HR and adjustments are made to the speed/angle of the treadmill… observations are being made and recorded, the service would be considered skilled and billable. All of the components of the service that represent skilled care must be documented. YES Supervision of one patient performing exercises in the absence of provision of skilled services is not billable. NO 24
    25. 25. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues (Q&A) Can joint mobilization be coded and charged by techs? YES, there is nothing in the DoD coding guidelines preventing military technicians from using 97140. – Military technicians need to have this training documented in their AFTR. – The supervising therapist is the final authority and responsibility in educating/training/certifying that the technician working under their plan of care is qualified to provide joint mobilizations. 25
    26. 26. PT Coding Issues 2010 UBO/UBU Conference Turning Knowledge Into Action  Modalities (97010 – 97039)  Supervised – Codes 97010-97028 – Does not require direct patient contact (1-to-1) – Time is NOT a factor – Only 1 unit/visit  Constant Attendance – Codes 97032-97039 – Requires 1-on-1 • Provider maintains visual, verbal, and/or manual contact with the patient throughout procedure  Time based—include time required to perform all aspects of service 26
    27. 27. PT Coding Issues 2010 UBO/UBU Conference Turning Knowledge Into Action  Supervised Modalities CPT Code Definition 97010 Hot / Cold pack 97012 Traction, mechanical 97014 E-stim (unattended) [Indications other than wound care] 97016 Vasopneumatic device therapy 97018 Paraffin Bath 97022 Whirlpool / Fluidotherapy 97024 Diathermy treatment Untimed codes Do not require 1-on-1 May only be used once per visit (regardless of number of areas treated) *Disposable electrodes are included and cannot be billed separately 27
    28. 28. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues Supervised Modalities – Documentation Requirements – Use codes 97010-97028 – Supervised by provider but does not require direct patient contact (one-to-one) – Time is not a factor—only 1 unit can be reported for each encounter 28
    29. 29. PT Coding Issues 2010 UBO/UBU Conference Turning Knowledge Into Action  Constant Attendance Modalities CPT Code Definition 97032 Electrical Stimulation (attended) 97033 Electric current therapy/Iontophoresis 97034 Contrast bath therapy 97035 Ultrasound therapy 97036 Hydrotherapy Requires 1-on-1 Provider maintains visual, verbal, and/or manual contact with the patient throughout procedure Time based—include time required to perform all aspects of service 29
    30. 30. 2010 UBO/UBU Conference Turning Knowledge Into Action  As of: PT Coding Issues Constant Attendance – Documentation Requirements Use CPT codes 97032–97039 Requires one-on-one contact – Provider maintains visual, verbal, and/or manual contact with the patient throughout procedure – Time based—include time required to perform all aspects of service 30
    31. 31. PT Coding Issues 2010 UBO/UBU Conference Turning Knowledge Into Action CPT Code Definition 97110 97112 Neuromuscular reeducation 97113 Aquatic therapy/exercises 97116 Gait training therapy 97140 Manual therapy 97150 Group therapeutic procedures 97530 Therapeutic activities 97532 Cognitive skills development 97533 Sensory integration 97535 Self care/management training 97537 As of: Therapeutic exercises Community/work reintegration 31
    32. 32. 2010 UBO/UBU Conference Turning Knowledge Into Action  As of: PT Coding Issues Documentation Requirements – Skilled services that affect change through the application of clinical skills and/or services that attempt to improve function – Requires direct, one-on-one patient contact by provider—maintain visual, verbal, manual contact with patient throughout procedure – For technicians, must be working under guidance of privileged provider – plan of care 32
    33. 33. 2010 UBO/UBU Conference Turning Knowledge Into Action    PT Coding Issues Therapeutic Procedures (97110-97546) Codes represent the majority of what is done Requirements as follows: – Skilled services – Requires 1-on-1 – Time-based codes – Provider maintains visual, verbal, and/or manual contact with the patient throughout the procedure 33
    34. 34. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues Do we need to document the specific amount of time spent performing each timed procedure? – Yes – 97110 (Therex) x 12 min SLR x 3 (3x15); SAQ (3x15); Wall Slides 3x25 – 97112 (Neuromuscular Re-Ed) x 13 min Single Leg stand Rebounder (3x25 tosses w/2# ball) 3 Dir hip kicks w/Tband on uninvolved (3x10) – 97010 (ice) x 15 min (untimed-use only once/visit) Total 1-on-1 time = 25 min Total treatment time (timed + untimed) = 40 min Documenting the time required to perform each individual exercise is NOT mandatory 34
    35. 35. 2010 UBO/UBU Conference Turning Knowledge Into Action  As of: PT Coding Issues Can I code for treatment during an evaluation? – YES, Documentation is the critical component – For example, if you evaluated a low back pain patient, you can code 97001 (eval) and then 97110 (10 minutes of therapeutic exercise instruction…if you instruct the patient and have them demonstrate proficiency in the same visit). 35
    36. 36. 2010 UBO/UBU Conference Turning Knowledge Into Action  PT Coding Issues (Q&A) Why would we use assisted exercises for ROM (97110) with PT neuromuscular re-education (97112)? – 97110  Exercises to develop strength, endurance, ROM, and flexibility – 97112  Activities to facilitate re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception  Ankle rehab to restore ROM (97110) and Single leg standing on a foam pad +/- Rebounder (97112) As of: 36
    37. 37. 2010 UBO/UBU Conference Turning Knowledge Into Action    As of: PT Coding Issues Orthotics and Prosthetics 97760-97762 replaced codes 97504/97520/97703 in 2006 – AMA says: “Orthotic management (97760) includes assessing the patient; determine the most appropriate orthotic (e.g., Static vs. dynamic); and designing, selecting, and fabricating the orthotic.” – “Also includes further orthotic training during follow-up visits including exercises performed in the orthotic, instruction in skin care, and orthotic wearing time.”  Extracted from APTA publication – Physical Therapy Reimbursement News – Volume 13, Number 2 (March/April 2006) Do not use with HCPCS Level II codes (L- and K-section) if in the description the assessment and fabrication is listed. 37
    38. 38. 2010 UBO/UBU Conference Turning Knowledge Into Action   As of: PT Coding Issues Can we use 97530? How is this different form 97110? – Yes – Therapeutic exercise (97110)  Includes activities related to strengthening, endurance training, ROM, and flexibility. These activities can include use of free weights, exercise machines such as treadmills or ergometers, and AROM/PROM – Therapeutic activities (97530)  Utilize dynamic activities to improve functional performance. Think of this as the “-ing” code, for example “lifting,” “pulling,” “pushing,” “running,” and “jumping.” If you are providing instruction in activities related to an actual activity, then the therapeutic activity code would be appropriate. Reimbursement, Coding, and Compliance for Physical Therapists The ABCs of CPT Coding, By Rhea Cohn, PT, MA // APTA Web site 38
    39. 39. 2010 UBO/UBU Conference Turning Knowledge Into Action    PT Coding Issues Direct Access – Initial Evaluation (situations requiring E code) Requirement for E-Codes (2.2.9) If performing DIRECT ACCESS and this is the first time the patient has been seen at the MTF for the current injury (due to external causes) E 800-999 & V71.3 – V71.6 Used to describe where, why, & how injury occurred – Coding  724.2 Low back pain  Exxx.x injury due to fall from ladder – Documentation  Should include DOI, location, if MVA related (state) or if work related (name of employer) As of: 39
    40. 40. 2010 UBO/UBU Conference Turning Knowledge Into Action    V Codes Use V-codes when the initial treatment of a disease or injury has been completed (via surgical or wound healing), but requires continued care during the healing phase or long term consequences of the condition/disease Aftercare Codes for Injury/Fractures – V53.7 V54.89 V54.81 V58.78 – V67.89 – – – As of: PT Coding Issues Orthopedic device fitting and adjustment Aftercare for healing fracture (NOS) Aftercare following joint replacement Aftercare following surgery of the musculoskeletal system (NEC) Follow up visit after all treatment is complete and patient no longer has diagnosis/problem for which they sought care 40
    41. 41. 2010 UBO/UBU Conference Turning Knowledge Into Action   PT Coding Issues Patient Education Capture patient education…which is critical component is under the one-on-one codes – 97110 – 97112 – Etc…based on what you are teaching – Key is to document what was covered 41
    42. 42. 2010 UBO/UBU Conference Turning Knowledge Into Action     As of: PT Coding Issues Group Therapy - 97150 Area of significant controversy Key issues – PT/OT services provided simultaneously to two or more individuals by a practitioner as group therapy. The individuals can be, but need not be performing the same activity. The PT/OT or PM Tech involved in the group therapy must be in constant attendance [providing feedback/actively involved], but one-on-one contact is not required. PM Technician codes = 97150 42
    43. 43. 2010 UBO/UBU Conference Turning Knowledge Into Action       As of: PT Coding Issues (Scenario) Patient is a “regular” She grabs her flow sheet and begins exercising independently (Bike x 10 min; Hamstring Curls 3 x 15; Leg Press 3 x 15; Fitter x 10 min) in gym. The PM tech is working with another patient across the room. Patient finishes the treatment and asks the tech for some ice. Independent exercise in the clinic is NOT a “skilled service” and cannot be billed/coded PM Technician codes = 97010 (1 unit)…THAT’S IT! 43
    44. 44. 2010 UBO/UBU Conference Turning Knowledge Into Action     PT Coding Issues Why can’t I get more than 4 CPT codes…& they’re missing my units of service? Problems with SADR Unable to capture the following: – Units of service – Modifiers – Any CPT or ICD-9 beyond four CAPER is coming soon to an MTF near you… 44
    45. 45. 2010 UBO/UBU Conference Turning Knowledge Into Action Questions ??? 45

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