Physical Medicine & Rehab Coding Alert

Use Therapy Codes for Pulmonary Rehabilitation, Not Cardiac

- Published on Wed, Aug 01, 2001
Over 15 percent of patients seeing rehabilitation physicians suffer from cardiac or pulmonary conditions that require the rehabilitative care of a physiatrist or therapist. While physiatrists manage these diseases through a combination of exercise, dietary consulting, stress management and family counseling, therapists perform a range of services from manual therapy to therapeutic exercise. Many coders are not familiar with coding for these types of diagnoses, since most of their patients normally undergo cognitive or musculoskeletal therapy. The following tips can help differentiate between these two potentially difficult procedures.   Cardiac Rehabilitation   While cardiac rehabilitation most often involves therapeutic exercise (97110) and physical and occupational therapy evaluations (97001, 97003), these codes are normally not covered for cardiac rehabilitation programs when billed on their own. Despite that fact, clinics and independent therapists mistakenly assign therapy modality codes for these services using heart disease ICD-9 codes, and their claims are rejected.
Sue McCallum, a coding supervisor with Randall/ Stuart Billing in Washington, D.C., who works for four rehabilitation clinics, says that using the PM&R codes for the modalities seems to be the logical choice, but is incorrect. "One of our cardiac rehabilitation bills was sent to us by a client. The patient, who had coronary bypass surgery, was in rehabilitation at an outpatient clinic to find low-stress ways to rebuild muscle and increase his cardiac strength. The clinic sent us their explanation of benefits (EOB), which showed that Medicare had rejected all of their rehabilitation codes. They were stumped. We looked up their local policy and found that individual physical and occupational therapy codes are not covered for this type of condition. The rehabilitation has to be billed by the physician under the overall cardiac rehabilitation codes."
The two cardiac rehabilitation codes, which are found in the Intracardiac Electrophysiological Procedures section of CPT (rather than the Physical Medicine and Rehabilitation section), are CPT 93797 (physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring [per session]) and 93798 (... with continuous ECG monitoring [per session]). The attending physician must refer the patient, and the treating physiatrist must be on the premises during the therapy and trained in advanced life-support techniques and exercise therapy for coronary diseases. Also, the facility must be equipped with all emergency lifesaving equipment medically necessary for a cardiac patient.     Greg Sweeney, PT, of the Cardiac Rehabilitation and Prevention Center at New York University Medical Center in Manhattan, says that a session billable under these codes would normally last about 90 minutes total. "For outpatient cardiac rehabilitation, we would have the patient perform three modalities of 15 minutes each, with rest and monitoring of their vital signs during and in between sessions. Training would [...]

Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*