This is a presentation kindly provided by Theresa BernerMOT,OTR/L on how to maximize revenue when doing wheelchair seating assessments.

1. Patient Benefit and Clinical Revenue in Seating and Positioning Theresa F. Berner, MOT, OTR/L Rehabilitation Team Leader Smart Wheel User Group Conference November 2, 2006

2. Overview Identify the CPT Codes utilized for seating and mobility therapy services. Understand the Medicare LCD documentation requirements for reimbursement. Identify weighting productivity to understand the therapists use of time. Identifying advanced training programs for Seating Clinics.

3. Therapy CPT Codes PT Evaluation: 97001 PT Re-evaluation: 97002 OT Evaluation: 97003 OT Re-evaluation: 97004 Assistive Technology Assessment: 97755 ALL EVALUATION CODES 2007 CPT code book. Professional Addition American Medical Association

4. Therapy CPT Codes Wheelchair Management and training 97542 Self-care/home mgmt. training 97535 Therapeutic Activities 97530 Community work re-entry 97537 Be aware of use of modifiers

5. Therapy CPT Codes Physical Performance Test or Measurement; 97750 One-on-one patient contact Objective findings of a patient’s condition or status that requires him/her to receive therapy services. Include functional capacity wheeled mobility evaluation.

6. PT/OT Evaluation: 97001/3 Components of the evaluation include the patient history, relevant review of systems, pertinent physical assessments and tests/measurements. The evaluation must state the reason for the initial referral to physical/occupational therapy.

7. PT/OT Re-evaluation: 97002/4 Continuous evaluation of the patient’s progress is a component of ongoing PT/OT services. A formal re-evaluation is covered only of the documentation supports the need for further tests and measurements after the initial evaluation. Indications for a re-evaluation include new clinical findings, a significant change in patient's condition, or failure to respond to the therapeutic interventions outline in the plan of care.

8. Wheelchair Management and Training: 97542 15 minutes This service trains the patient in functional activities that promote optimal safety, mobility and transfers. Patients who are wheelchair bound may need skilled instruction on positioning, positioning supplies, and wheelchair modifications to avoid pressure points, contractures, and other medical complications.

9. Wheelchair Management and training: 97542 Typically 3-4 sessions are sufficient to teach the patient and/or caregiver these functional skills unless the patient is severely impaired or presents with another condition requiring additional treatment sessions. Subsequent visits may be occasionally necessary for the re-evaluation and modification of the wheelchair management and propulsion training in patients with neurological disorders such as ALS, MS or Parkinson's disease.

10. Wheelchair Management and training: 97542 Documentation must relate the training to expected functional goals that are reasonably attainable by the patient and/or caregiver. Be aware to document medical necessity when going beyond the 3-4 visits.

11. Assistive Technology Assessment: 97755 To restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility Direct one-on-one contact by provider with written report Each 15 minutes (To report augmentative or alternative communication devices, use 92605, 92607)

12. Billing Combinations Can not bill 2 evaluation codes together Higher charge will be bumped out. Should not have variations of evaluation charge: i.e.: eval; brief eval Higher charge will be bumped out Can bill Assistive Tech + w/c mgmt together - or- Eval + w/c mgmt.

13. Medicare LCD requirements Medical Code Therapy Code; Clinicians must pick from LCD Functional level at the start of care Objective tests and measures Functional loss; why skilled therapy is needed (self-care, mobility, safety)* Pain Assessment History of illness www.adminastar.com

14. Functional Loss* Self-care dependence: i.e., loss of ability to feed self, to dress, or maintain personal hygiene. Mobility dependence: i.e., transfer ability, gait training, stair climbing, wheelchair mobility, level of strength, muscle spasticity, pain level, joint contracture, coordination level, perceptual motor loss, need for orthotics or mobility device.

15. Functional Loss* Safety issues: i.e., high probability of falling, swallowing difficulties, severe loss of sensation, progressive joint contracture, and infection.

16. Internal Productivity RVU: The calculated amount of time it takes to produce 1 unit of service. Represents a weighted amount used in productivity formulas to adequately represent time required for productivity. Includes documentation time, materials, travel, patient preparation, supplies, etc. Ensure your CPT codes have accurate RVU weights. These are facility specific.

17. Think Differently Seating Clinics can be a referral base into your outpatient clinic. Try not to do everything all in one visit. Develop Clinical Guidelines and Pathways using seating. Integrate with other departments. Think about volume and program growth. Use data to return demonstration for minor equipment and FTE’s. The volume generated from referrals can pay back dollars spent on equipment.

18. Think differently Build case for increased FTE by increasing growth from a new referral base (clinics). Look at where referrals are coming from and take time to educate them on outcome of your referral and state of the industry. Links with Driving Rehab Programs; working with BVR and BWC.

19. Program Development Wheelchair Seating Clinic Power Wheelchair Training Propulsion Training Pressure Mapping Assessments Neuro Rehab Referrals Custom Molding

24. Propulsion training Identification of fitting and adjustments Investigating where they are wheeling and what they are doing/not doing Training on propulsion efficiency Advanced wheelchair training Final fitting and necessary follow up

25. Example of referrals for growth

26. 1 eval 1 AT 3 w/c 1 AT 3 w/c 1 AT 3 w/c Instead of 1 visit for w/c eval, below is gained Visits= 8 UOS = 27

27. Program Development Looking into lifestyle needs and opportunities for increased independence. Use of good interviewing skills. The billing is driven on what your goals and perspective. Documentation needs to reflect the CPT codes used.

28. Opportunities for Collaboration Physician Clinics PM&R MS Centers MDA/ALS Centers Local family practices Movement Disorder Clinics Wound Care Centers; Plastic Surgery Your own clinics!!