billing, CPT codes – Flashcards
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CPT 97000 series
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-specific to physical medicine and rehab
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what are apart of these codes
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-eval and reeval -modalites, supervised and constant attendance -therapeutic prodecures -tests and measures -orthotic and prosthetic management
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how do therapists report/specify diagnoses when billing for services
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-ICD 10 -HIPPA mandated coding system
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ICD10, HIPAA
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-used in all medical billing -medicare part A(hospitals, SNF, scute centers) -all OP medicare part B -utilized by most payers
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tracking and billing of medicare minutes for OP
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8 minute rule -based on: -documented number of mins form timed procedures, based on CPT codes, and 8 min rule -documented non-timed
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2 categoreis for CPT codes
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service based: time based
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service based
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-not time based -does not consider the amount of time it takes the therapist to complete -ex: traction, eval, reeval
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time based code
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-allows for variable billing in 15 min increments
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non timed procedures
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eval -speech therapy eval -whirlpool -mechanical traction -diathermy -paraffin bath -wound care -group therapy
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Eval, PT
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97161, 97162, 97163
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Re eval
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97164
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Evaluation OT
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97165, 97166, 97167
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reeval, OT
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97168
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HPs and CPs
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bundled into otehr services and will not be paid for by Medicare
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supervised modalities
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untimed procedures -only be billed 1x/day regardless of body parts
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PT eval/reeval
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97001, PT eval for start of episode of care -reeval: 97002, comprehensive and not used at every visit
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1 unit
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15 minute increment
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therapeutic activity
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97530
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manual therapy
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97140
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aquatic therapy
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97113
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neuro re-ed
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97112
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assistive technology assessment
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-97755
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therapeutic exercise
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97110
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self care management
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97535
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gait training
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97116
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cognitive skill development
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97770
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8 minute rule
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to bill for each additional time-based code -therapist must spend at least 8 mintues of each unit providing direct service to pt
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to bill for a 15 minute code
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-mediare requires that the session be at least 8 mins long
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1 unit
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-8-22 mins
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2 units
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23-37 mins
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3 units
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38-52 mins
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4 units
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53-67 mins
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5 units
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68-82 mins
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6 units
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83-98
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guidelines
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-1st procedure must be at least 8 mins -each one thereafter billed in 15 min incremints -only documented direct, face to face time -excludes rest time for toileting, time spent waiting for equiment
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minumum for 2 units
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-23 mins
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constant attendance modalities
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timed -estim: 97032 -ionto: 97033 -US: 97035 -direct contact required -involve 1 or more areas
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manual therapy
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-mobilizations -manips -manual traction -manual lymphatic drainage
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therapeutic activities
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-dynamic activities to improve functional performance -transfer training -self-care management
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wheelchair managemnt
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-97542 -assessment, fitting, training
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Tests and measures
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-97750, performance testing -FCE: funtional capacity eval -97755: assistive technologies assessment --seating, mobility, environmental controls -timed, require written reports
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assistive tec
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assis
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tracking of minutes
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number of units billed is determined by the total time for all timed based services -total number of units limited by total tx time
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24 mins of ther ex, 23 mins of sensoyr integration, total tx time of 47 mins, how many units?
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3 -1 unit of sensory -2 of therex -assign more units to service that takes most time
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billing overall
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all non-timed CPT procedures provided without respect to time -bill for appropriate time based CPT that are >8 mins -total minuts of all time based procedures AND appropriate of units based on total minutes of procedures
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ABN
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advanced beneficiary notice -expect medicare will deny reimbursement -giving advanced notice to pt -notifying pt in writing that medicare will likely deny payment -allow you to bill pt for services that would typically would be denied by medicare
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NEMB
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notice of exclusion form medicare benefits -inform beneficiaries of medicares financial limitations -inform pt of their responsibility for all costs over the cap limit or services that medicare does not normally pay for -
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purpose of NEMB
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-help pts make informed choices about whether or not they want to receive services or items knowing medicare will not pay for them
