Documentation for PTs: CPT codes and G codes – Flashcards
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Eval code for a) no personal factors/no comorbidities b) involving 1-2 elements when it comes to systems and c) patient presents stable ; low complexity
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97161
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Eval code for a) 1-2 personal factors/comorbidities b)involving a total of 3-4 elements when it comes to systems and c) pt presents as evolving ; moderate complexity
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97162
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Eval code for a) 3/more personal factors/comorbidities b) involving a total of 4/more elements for systems c) unstable patient ; high complexity
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97163
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Physical Therapy reevaluation code
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97164
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Evaluation code for worker's comp & auto liability
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97001
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Total evaluation time associated with low complexity
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20 minutes
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Total evaluation time associated w/ moderate complexity
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30 minutes
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Total evaluation time associated w/ high complexity
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45 minutes
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Complexity refers to...
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level of clinical decision making needed for patient
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physical performance test/measurement (musculoskeletal. functional capacity), eac 15 mins
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97750
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range of motion measurements
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95851 / 95852
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Motion analysis completed via video
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96000
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Motion test w/ foot pressure measurement
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96001
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Dynamic surface electromyography
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96002
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Dynamic fine-wire electromyography
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96003
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Ther ex to develop strength, ROM, flexibility and endurance w/ direct contact, ea 15 mins
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97110
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Neuromuscular reeducation w. direct 1-1 contact
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97112
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Aquatic therapy w. ther ex, 1-1 contact
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97113
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Group therapeutic procedures, requiring direct contact of provider w. group
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97150
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Gait training w. S (S from here on out = with PT supervision)
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97116
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massage, therapeutic w. direct 1-1 contact
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97124
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manual therapy techniques w. direct 1-1 contact
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97140
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therapeutic activities, use of dynamic activities to improve functional performance w S
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97530
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cognitive skills development
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97532
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self-care/home management trng
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97535
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community/work-reintegration trng
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97537
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w/c management (assessment, fitting, training), etc.
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97542
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work hardening/work conditioning, each 2h
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97545
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work hardening, work conditioning, for each additional h
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97546
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sensory integration
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97533
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mechanical traction, 1/> areas
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97012
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electrical stimulation
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97014
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vasopneumatic device therapy, 1/> areas
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97016
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Paraffin bath, 1/> areas
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97018
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whirlpool therapy (non-Hubbard tank)
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97022
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Diathermy, 1/> areas
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97024
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infrared therapy, 1/> areas
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97026
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ultraviolet therapy, 1/> areas
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97028
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electrical stimulation S, manual
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97032
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electrical current therapy/iontophoresis, S
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97033
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contrast bath, S
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97034
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ultrasound, S
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97035
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Hubbard tank, S
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97036
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application of neurostimulator
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64550
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selective debridement, first 20cm^2 or less
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97597
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selective debridment, greater than 20cm^2
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97598
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nonselective debridement
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97602
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negative pressure wound therapy, less than/= to 50cm^2
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97605
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negative pressure wound therapy, greater than 50cm^2
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97606
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negative pressure wound therapy, using dme, less than/= 50cm^2
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97607
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negative pressure wound therapy using dme, greater than 50cm^2
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97608
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low-frequency, noncontact nonthermal Ultrasound/day
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97610
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orthotic(s) mngmt and trng (including assessment & fitting)
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97760
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prosthetic trning, UE and or LE
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97761
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checkout for orthotic/prosthetic use
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97762
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education and trng for patient self-mngmt by a qualified, nonphysician health care professional using standardized column
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98960
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education and trng for patient self-mngmt by a qualified nonphysician health care professional for 2-4 patients
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98961
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education and trng for patient self-mngmt by a qualified nonphysician health care professional for 5-8 patients
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98962
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biofeedback trng
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90901
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biofeedback trng, perio/uro/rect
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90911
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Canalith repositioning procedures (Eply maneuver, Semont maneuver)
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95992
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online assessment and mgnt service
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98969
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medical team conference w. interdisciplinary team of health care professionals, pt and or family present
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99366
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medical team conference w. interdisciplinary team of health care professionals, pt and or family not present
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99368
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Refresher: HIPAA stands for?
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Health Insurance Portability & Accountability Act
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True/False: Incident reports are only completed after an unfortunate event has occurred.
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False- they can also be completed for a potential threat/adverse occurence
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CSM stands for
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Center for Medicare and Medicaid
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CSM is under what US Branch?
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US Department of Health and Human Services
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What is Medicare A?
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Insurance that covers hospital stays, skilled nursing facilities, hospice care, & home health
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What is Medicare B?
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medical insurance that covers outpatient services, medical supplies and preventative needs
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Who is eligible for Medicare?
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People over the age of 65 years, some individuals w/ a permanent disability and those with ESRD (End Stage Renal Disease)
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"Fee for service" is associated with what part of Medicare?
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Medicare Part B
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Those that are eligible for MedicAID are...
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people who meet the financial requirements, or permanent disability. Established by each state.
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G-Codes are related to...
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Medicare Part B
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Incident reports require what 6 components?
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a) subject demographics, b) date of incident, c) type of incident, d) condition of subject, e) course of action taken, f) witnesses, if any
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The purpose of evaluation code changes in January 2017 was to go from what fee-for-service to...?
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focus on the quality of care given, and the complexity of clinical reasoning skills needed, as well as achievement of functional outcomes.
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DRG codes stand for? and are required for what?
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Diagnostic-Related Codes; Medicare Part A
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G-Codes have 3 variants of the same status for:
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a) Current Status b) Projected Goal Status (add 1 to original code) c) Discharge Status (add 2 to original code)
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Mobility and Walking around- Current Status
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G 8978
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Changing & Maintain Body Positions - Current Status
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G 8981
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Carrying, Moving and Handling objects - Current Status
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G 8984
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Self-Care - Current Status
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G 8987
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Other PT/OT Primary - Current Status
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G 8990
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Other PT/OT Subsequent - Current Status
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G 8993
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G Code modifiers' purpose:
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indicate the patient's functional limitation reporting.
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Each G code must have a ________________, no matter the time of documentation.
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modifier
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G Code modifier: CH
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0% impaired, limited or restricted
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G code modifier: CI
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1-20% impaired, limited or restricted
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G code modifier: CJ
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At least 20% but less than 40% impaired, limited or restricted
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G code modifier: CK
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At least 40% but less than 60% impaired, limited or restricted
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G Code Modifier: CL
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At least 60% but less than 80% impaired, limited or restricted
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G code modifier: CM
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At least 80% but less than 100% impaired, limited or restricted
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G code modifier: CN
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100% impaired, limited or restricted
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CPT codes that are time based must included treatment that is at least ....
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8 minutes
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CPT codes are based on a unit of
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15 minutes
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1 unit of time (for CPT codes) =
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8 - 22 minutes
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2 units of time (CPT)
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23 - 37 minutes
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3 units of time (CPT)
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38 - 52 minutes
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4 units of time (CPT)
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53 - 67 minutes
