For example, overhead shoulder movement can be strengthened by reaching up to place a weighted object on a shelf. But as a rule, we try not to do more than six patients at a time, he adds. We need to be informed of how to properly bill for our services to ensure small business success. However, private payers often create their own edit pairs; therefore, there is no guarantee they will pay, even with an applied modifier 59. This type of code can only be used once for an individual treatment and must not be included as part of billing calculations for timed treatment. Therapeutic Exercises are used for the purpose of restoring strength, endurance, range of motion, flexibility, where loss or restrictions is a result of a specific disease or an injury and has resulted in a functional limitation. The time spent by A and B starting at 9:45 in the gym in not billable as the physical therapist is not in constant attendance.
However, if a service represented by code 97760© orthotic management and training was performed on an upper extremity and a service represented by code 97116© gait training was also performed, both codes may be billed with modifier 59 to denote separate anatomic sites. Coding: Patient A: 97110 therapeutic exercise ; 97140 manual therapy Patient B: 97140 manual therapy Rationale: Between 9:00 and 9:30 Patient A receives one unit of therapeutic exercise 97110 and one unit of manual therapy 97140. Not only is it controversial nationwide, but among the states, there are varying interpretations of the group code. The patient rests for 5 minutes. However, therapeutic exercises -- usually passive -- begin early in the rehab process to keep the joint from getting stiff.
They can be active, active-assisted, or passive movements. When only one outcome is expected, they are performing a therapeutic exercise. Appropriate billing for 47 minutes is only 3 timed units. Untimed codes: When an untimed code is used, there is a predetermined fee for the session, regardless of the type of treatment, modality or the number of areas of the body being treated. What is a Therapeutic Exercise? When it comes down to it, insurance companies are businesses.
We need to record the exact minutes of treatment time you spend with your patient. Modifier codes must be included. Additionally, you need to show how you are transitioning those exercises over to a home exercise program. Common billing blunders Fixed rate payers: Medicare and other insurance companies have a capped, daily amount for payment. The patient having paralyzed musculature contributing to impaired circulation b. The procedure may be medically reasonable and necessary for impairments which affect the body's neuromuscular system e.
If more than one 15-min timed code is billed on a calendar day, the total number of units that can be billed is constrained by the total treatment time. Bailey is also a certified hand therapist. They require the professional skills of a provider and are designed to address a specific functional need of the patient. It might be covered by a commercial insurance but for Medicare purposes, Iontophoresis is not covered. Sit to stand activities continue to improve leg strength while practicing a daily task. Supervised Exercise Eight patients are participating in an hour-long exercise program in a physical therapy clinic. Maybe it's not the set-up or the progression of the exercise, but maybe you're monitoring that patient's vital signs or you're teaching the patient how to monitor his or her own vital signs.
Exercise just to promote overall fitness, flexibility, or endurance, in absence of a complicated condition are not covered. From 9:40-9:55, patient B receives one-on-one manual therapy, which is therefore billable as 97140. Point of care documentation occurs when you're sitting there with your patient and discussing this is how I thought you did today, for example. Instead of performing a single, specific, physical movement, the patient will be engaging in a functional task such as throwing a ball, pushing a cart, or even activities like cooking. The activities are usually directed at a loss or restriction of mobility, strength, balance or coordination. It also should provide verification of professional judgment. Consider the following points when determining if a service is skilled.
It is imperative we demonstrate our skilled therapy, since that justification acts as an argument for what we are doing. There must be an expectation that the condition or level of function will improve within a reasonable and generally predictable time or the services must be necessary to establish a safe and effective maintenance regimen required in connection with a specific disease. Bill 2 units of 97110 and 1 unit of 97140. The physical therapist would not bill group because there is not the initial 20 minutes with all three patients that occurred in scenario 5a. All techniques applied on the same date of service should be totaled into the time calculated for the code.
It is best practice to record your minutes and then convert those minutes over to units. The time spent waiting to use a piece of equipment or for other treatment to begin is not considered treatment time. In a nutshell, this modifier indicates that two linked services were actually performed separately and independently of one another. Disclaimer: These are intended to be examples of proper coding for billing purposes They are not intended to establish a standard for clinical practice. Its hard to know when to use a modifier and when to just schedule the visits separately. At 9:20, the physical therapist performs shoulder stabilization exercise techniques with patient A, while patient B and C continue with their strengthening exercises. Modifier 52 should not be used for therapy services less than 15 minutes.
They have all recently been fitted with lower limb prostheses. Check out , , and. Individual techniques should not be separately coded or billed since it is a time-based code. Do not bill 3 units for either one of the codes. Therefore, group therapy sessions two or more patients should be of sufficient length to address the needs of each of the patients in the group. The group code is extremely confusing, says Diane McCauley, who handles the billing at Northstar Physical Therapy in Ironwood, Mich.