12/4/2014
Physical Therapy
Presented by Regan Tyler, CPC, CPC-H, CPC-I, CPMA, CEMC Senior Consultant & NAMAS Instructor
Agenda
• Time based billing • Therapeutic procedure(s) documentation • Group therapy documentation • Legibility • Signature requirements • Physical therapy assistants
Time Based Billing
Documented Time (Minutes) Number Units 0-7 0 8-22 1 23-37 2 38-52 3 53-67 4 68-82 5
Must reach the half-way point of the time unit (15 min) to reach the next unit
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Therapeutic Exercise
97110 Therapeutic exercises to develop strength and endurance, range of motion and flexibility
• Documentation must explain the actual exercise(s) done • Time for each separate exercise should be documented and/or repetitions
Therapeutic Exercise
• Treadmill • Bike • Elliptical • Lunges • Jumps • Weights / weight machine
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Therapeutic Exercise
• Majority of therapists will document start and end times, and individual exercises are counted in reps/weight • Verify time is accurate for units billed and documentation of specific exercise is found
Neuromuscular Reeducation
97112 Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities
Examples: • Proprioceptive neuromuscular facilitation (PNF) • Feldenkreis • Bobath • BAP’s boards
PNF Stretching
• Set of stretching techniques commonly used in clinical environments to enhance both active and passive range of motion with the ultimate goal being to optimize motor performance and rehabilitation o Stretching then contracting the isolated muscle
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Feldenkreis
• The practitioner directs attention to habitual movement patterns which are inefficient or strained, and teaches new patterns using gentle, slow, repeated movements
Bobath
• Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. • This is done through specific patient handling skills to guide patients through initiation and completion of intended tasks o Commonly utilized after stroke
Biomechanical Ankle Platform System
Used to improve balance and proprioception in the ankle, knee, and hip
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Aquatic Therapy
97113 Aquatic therapy with therapeutic exercises
• Any type of exercise performed in a water environment • Do not report a code for the water modality (Hubbard Tank, whirlpool)
Gait Training
97116 Gait training (including stair climbing)
• Training the manner or style of walking, including rhythm and speed o Stance phase o Swing phase o Double support phase
Massage
97124 Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
Effleurage: light massage stroke used in Swedish massage prior to deep tissue work
Petrissage: deep and compressing massage movements
Tapotement: rhythmic percussion used in massage
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Therapeutic Procedures
• All codes in range (97110-97124) billed in 15 minute units • 7 minutes or less is not reportable • In and out times not required but individual modality times are
Manual Therapy
97140 Manual Therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes
Hands-on therapy techniques.
Manual Therapy
• Connective tissue massage • Joint mobilization and manipulation • Manual lymphatic drainage • Manual traction • Passive range of motion • Soft tissue mobilization
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Supervised Modalities
97010 hot or cold packs 97012 traction, mechanical 97014 electrical stimulation (unattended) 97016 vasopneumatic devices 97018 paraffin bath 97022 whirlpool 97024 diathermy (microwave) 97026 infrared 97018 ultraviolet
Supervised Modalities
• PT remains in the room and available but does not need to be one-on-one
• No time associated with these services
Constant Attendance Modalities
97032 electrical stimulation (manual) 97033 iontophoresis 97034 contrast baths 97035 ultrasound 97036 Hubbard tank
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Constant Attendance Modalities
• All codes are billed in 15 minute increments
• Require one-on-one attendance by provider
Group Therapy
97150 Therapeutic procedure(s), group (2 or more individuals)
The health care provider supervises group activities (two or more patients/clients) during therapeutic procedures on land or in the aquatic environment. The patients/clients do not have to be performing the same activity simultaneously; however, the need for skilled intervention must be documented. This code can be reported once for each group participant.
Group Therapy
• No time associated with group therapy
• Can be reported on the same day as one-on-one services
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Group Therapy
Per CMS: Group therapy consists of simultaneous treatment of two or more patients who may or may not be doing the same activities. If the therapist is dividing attention among the patients, providing only brief, intermittent personal contact, or giving the same instructions to two or more patients at the same time, it is appropriate to bill each patient one unit of group therapy, 97150.
Group Therapy
• In order to bill for therapeutic exercise/activities that require one-on-one care from the PT, time must not be split between patients. • It is appropriate to spent time in chunks, for example 4 minutes on one exercise, have that patient do a unsupervised modality for 10 minutes, return and do 8 additional minutes of exercise. • If time cannot be directed one-on-one, group therapy should be reported
Legibility
• All documentation must be legible o If not legible one could dictate for clarity and submit both notes when requested
• Create an “approved” acronym and symbol list
• Have a standard for documenting times and repetitions o Are you capturing in and out times? Is everyone?
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Legibility
• If you don’t know what an acronym is, just ask
• If you don’t know if it’s a time (minutes) or a repetition, just ask
Physician Order
• During an audit you should be verifying there is an appropriate physician referral for services • Verify appropriate communication occurs between the PT and physician
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Signature Requirements
• Like all medical records, PT records must be appropriately signed • If handwritten notes, verify a signature log is available
Physical Therapy Assistants
• Licensed to work in all states • Licensed in some states to work unsupervised • CMS requires PTAs to be supervised
Physical Therapy Assistants
Per CMS: “A physical therapist must supervise PTA’s. The level and frequency of supervision differs by setting and by state or local law. General supervision is required for PTA’s in all settings except private practice, which requires direct supervision, unless state practice requirements are more stringent. In these cases, state or local requirements must be followed. See specific settings for details…”
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Physical Therapy Assistants
General supervision
• The procedure is furnished under the physician’s overall direction and control in the office setting. • The physician’s presence is not required during the performance of the procedure. • The physician is responsible for ensuring that the non-physician personnel who actually perform the diagnostic procedure are trained and are responsible for ensuring the maintenance of the necessary equipment and supplies to perform the tests.
Physical Therapy Assistants
Direct supervision
• A physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure in the office setting. • The physician does not have to be present in the room when the procedure is performed.
Physical Therapy Assistants
• The services of PTAs used when providing covered therapy benefits are included as part of the covered service. These services are billed by the supervising physical therapist. PTAs may not provide evaluation services, make clinical judgments or decisions or take responsibility for the service. They act at the direction and under the supervision of the treating physical therapist and in accordance with state laws.
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Physical Therapy Assistants
• A physical therapist must supervise PTAs. The level and frequency of supervision differs by setting (and by state or local law). General supervision is required for PTAs in all settings except private practice (which requires direct supervision) unless state practice requirements are more stringent, in which case state or local requirements must be followed. See specific settings for details. For example, in clinics, rehabilitation agencies, and public health agencies, 42CFR485.713 indicates that when a PTA provides services, either on or off the organization’s premises, those services are supervised by a qualified physical therapist who makes an onsite supervisory visit at least once every 30 days or more frequently if required by state or local laws or regulation.
Physical Therapy Assistants
• The services of a PTA shall not be billed as services incident to a physician/NPP’s service, because they do not meet the qualifications of a therapist.
PT Modifiers
GN Services delivered under an outpatient speech- language pathology plan of care; GO Services delivered under an outpatient occupational therapy plan of care; or, GP Services delivered under an outpatient physical therapy plan of care. KX: Cap exception
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Therapy Cap
Outpatient financial limitations are listed on the CMS website • Publication 100-04, Chapter 5, Section 10.2
• $1920 – PT and SLP combined • $1920 – OT
Modifier KX
• Documentation must be found to support the requirement of continued therapy services over the therapy cap • Use of modifier KX does not require documentation to be sent • Patients receiving over $3840 total in therapy services will prompt a manual review by CMS
Can we correlate time per service to the breakdown of activities?
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Audit Reminders
• Verify referral from MD • Verify continuation of plan from MD • Notes complete, legible and signed and include progress • Timed codes supported (Including 1 patient at a time) • PTA’s used appropriate • CMS – modifiers supported by documentation
AAPC CEU # 38875RGS
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National Alliance of Medical Auditing Specialists
10401 Kingston Pike, Knoxville, TN 37922 P: 1-877-418-5564 F: 1-865-531-0722 Web: www.NAMAS.co Email: [email protected]
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