Eli's Rehab Report

Avoid Common Errors When Billing for Physical Therapy

- Published on Wed, Mar 01, 2000
Nugget: Your notes on the record, along with a complete patient history, may be more important than the CPT code.

The Office of the Inspector General (OIG) reports there are a number of common errors that physical therapists (PTs), occupational therapists (OTs) and coders make when they bill for therapy services, particularly involving those provided in skilled nursing facilities (SNFs).

In a report released in August 1999 the OIG stated that 13 percent of physical and occupational therapy administered in SNFs was billed improperly, while an additional 14 percent was documented improperly. The random sampling of 218 Medicare patients records took place in March 1998, before the implementation of the July 1998 SNF prospective payment system, which now pays SNFs facility-specific per diem rates (including therapy) for each patient in a Medicare Part A covered stay. The OIG report described situations where patients had already reached their treatment goals, the treatment goals were unattainable, therapy was not discontinued at the appropriate time and therapists billed routine maintenance as skilled therapy.

Establishing Plan of Care is Key

Judy Thomas, director of the reimbursement and regulatory policy department of the American Occupational Therapy Association in Arizona explains, Maintenance services are generally considered routine therapy that does not require the skills of an OT. Often, after a person reaches his or her therapy goals an OT will develop a maintenance plan for such things as routine exercises or daily activities that an aide or tech can supervise. Establishing the plan would be considered occupational therapy, but the activities themselves are not.

When a PT does his or her monthly re-evaluation of the patients plan of care, the coder or PT should bill 97002 (physical therapy re-evaluation) instead of billing for a therapeutic service (97110-97139), says Amy Nasser, a practicing physical therapist in Kansas City, Mo., who works twice weekly with SNF patients. Many providers wont even pay for general maintenance, which is when theres no real chance of improvement. When were trying to keep someone status quo but not working toward improving their condition, for example in cases of chronic pain resulting from a degenerative nerve disease, we might apply hot packs (97010) or put them in a whirlpool (CPT 97022 ). But we cant bill that the same way we would bill something like manual traction (97140), which is used when were functionally moving toward a goal of either managing pain better, or improving strength, mobility or functions. Unfortunately, many state Medicare carriers do not recognize general maintenance services, which is probably why people were erroneously upcoding to skilled therapy.

Thomas points out that therapists cant always predict the outcome of their services. Sometimes reviewers will treat therapy as maintenance [...]

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