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Re: Physical,occupational, and speech therapy

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shanbull:

--- Quote from: Reichl2014 on October 11, 2014, 06:55:31 AM ---

Thanks so much for all the info. Really helped. Also sent fraud info to the owner.  Do u have any issues with coding  for instance 97003 with 97530 and using modifier 59 on same day. ?  Anything to be aware of when therapists do documentation besides time. Gayle

--- End quote ---

There is no conflict billing 97530 with modifier 59 along with either 97001 or 97003. There is a conflict billing it with re-evaluation (97002 or 97004.)

This is the Medicare page where you can download the code pair edits: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html?redirect=/nationalcorrectcodinited/
Here is a document on how to read the edits: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf

As for documentation aside from time, make sure all measures used in the evaluation are updated with current status at each appointment (so for example, pain levels always should be documented, functional limitation status should be updated including range of motion and other objective measures that apply), the patient's "homework" until the next treatment should be included. Basically, anything that is done during the appointment should be documented so that if an insurance company requests records, it's very easy to show that what was billed for was actually done. An evaluation generally contains one section on "History" which will explain what led the patient to need therapy, any relevant symptoms/medical history and information from previous treating providers, baseline pain levels and limitations, and probably anything a parent mentions that might be helpful information to refer to later. Next would be the "Physical Exam" section which would go into more specific measures like range of motion, strength, gait, balance, reaction to palpation, and special testing. Next section would be "Therapeutic Interventions" where the provider will document what treatment was done, on what body part(s) and for how long. Next section would be "Diagnosis/Assessment" and the provider will note all relevant diagnoses made during the evaluation, and then write out a treatment plan including objective goals to be measures at further appointments, including long-term and short-term. The final section would be "Treatment" where the provider will document for each diagnosis what treatment will take place, plus frequency and duration prescribed for each treatment. At subsequent appointments most of this info will be exactly the same, with an update on how things went on each particular date for the patient and any necessary changes to the treatment plan of course can be made. At the discharge appointment the "Physical Exam" section will need to be updated with the patient's status as of the end of treatment, and documentation addressing whether each of the goals in the "Diagnosis/Assessment" section have been met.

You can probably find several different formats for initial evaluation and appointment notes on Google, all providers have their own style and order in which they like to do things. I just outlined the general structure our providers prefer to use.

medwave:
Codes and modifiers are listed for the three that you've questioned.

Physical Therapy
Occupational Therapy
Speech Therapy

New CPT Codes for Physical Therapy
97161 – Physical Therapy Evaluation – Low Complexity
97162 – Physical Therapy Evaluation – Moderate Complexity
97163 – Physical Therapy Evaluation – High Complexity
97164 – Physical Therapy Re-evaluation

Hope that helps! :-)

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