Medical Billing Forum

Billing => Billing => Topic started by: Anne on July 30, 2008, 09:30:05 AM

Title: limit on number of units per day - PT and OT
Post by: Anne on July 30, 2008, 09:30:05 AM
I bill for PT and OT (in the same group of therapists).  Can both the PT and OT treat the same patient on the same day?  Sometimes they use the same codes - such as 97110.  Is there a limit to how many units of a certain type of therapy can be done on the same day?

Another group of PT's that I bill for - had a week of "therapy camp" they called it, for several of their special needs patients (children with CP and other severe cases).  They treated some these children for several hours each day that week.  The care-givers were present also.  Sometimes two PT's would work together with one child while the care-givers took care of the other children.  Sometimes it was one on one.  They have given me charges to file up to 10 units in some cases on the same day, same code.  Should I use modifiers to indicate reason for that much therapy that day?  Should I have gotten special auth for therapy like that? - (which I didn't do beforehand).  Are there codes that indicate that some of the time was with two PT's?  Should I send in notes along with the claims?  Thank you in advance for any advice.
Title: Re: limit on number of units per day - PT and OT
Post by: Michele on July 30, 2008, 09:59:47 AM
Wow, you actually have many questions in one here.  Unfortunately many of the answers are going to vary by insurance carrier.  I will try to answer generically the best I can. 

First, on PT & OT being done on the same date.  This is definitely going to depend on the insurance you are billing.  I'm assuming the PT & OT are both billing under the same group name & tax ID # which will make the services look like duplicates.  I would recommend billing them out on separate claims (PT on one, OT on another).  You can either wait for one to be denied as a duplicate and appeal it with an explanation, or attach a note of explanation to the claim on the first submission (my recommendation). 

As far as the "therapy camp"  (which sounds like it could be quite effective and make the therapy fun for the kids) again, it is going to depend on the insurance you are billing.  Most insurances have either a global allowance or a set fee they allow per visit so even if you bill 10 units and a modifier, it most likely won't matter.  For those companies you may want to contact provider relations and ask if there is any review process so that they can consider the specifics.  If you can't contact the provider relations I would submit the claims along with a note of explanation and if they are still processed at a very low allowance, send in a written appeal explaining in detail what therapy was performed.

As for some insurances(unfortunately, not very many), they will just process your claim as submitted with the units etc. 

If it is feasible for you I would go ahead and attach the notes, with the note of explanation to the claims on the first submission.  It may reduce time in getting the claim appealed if they already have all info on file.

I probably would have called prior to the therapy camp date to inquire (maybe just a couple of the major insurance carriers) to see how they would consider this type of treatment.  But hindsight is 20/20.

Hope this is helpful!
Title: Re: limit on number of units per day - PT and OT
Post by: Anne on July 30, 2008, 11:38:37 AM
Thank you, I know my question was rather complicated.  I'll have to see how it goes, but I know it will involve appeals, etc.  Most are with United Healthcare.  You're right about calling ahead - should have done that.