Re: HCPCS coding and PPS tracking -Reply

[Guest guest]

Tina's interpretation is correct; timed CPT procedures are up to 15

mins, therefore if you spend only 5-10 minutes doing that specific

procedure then you would still report 1 even though you did not spend 15

mins doing the procedure. In the same way, SLP's may spend 45 mins with

speech treatment and yet can only report 92507 once because this is an

untimed CPT procedure. Now, they may report other CPT procedures like

97770 if they were working on cognitive development during the speech

treatment but this depends on the tx plan.

Trying to match minutes or mods with the number of CPT codes will only

frustrate you because an hour long treatment by a therapist may involve

1-6 CPT procedures. Changing the mindset of therapists to understand

the difference between CPT procedures and mods/minutes can be difficult.

Dean Myers

Re: HCPCS coding and PPS tracking -Reply

We are developing a " Daily Treatment record " that includes:

Start and stop time of visit

Date, therapist signature

Charge for treatment

and a note on the treatment rendered.

I think that this will address everything that we need to document to

support the MDS and state regs.

As far as CPTs go, my understanding is that for the ones that are

defined by 15 minutes of treatment: that this means 1-15 minutes of

that

procedure. So, if my therapist did 25 minutes of gait and 10 minutes of

therapeutic exercise: they would charge (2) gait and (1) ther ex.

Any other interpretations would be appreciated.

TIna

Indpls, IN

>>> Rich 10/14/98 05:43pm >>>

Any suggestions as to how to track PPS minutes and HCPCS

charges

in one sheet for a subacute unit in a LTC facility? My understanding is

that PPS minutes are tracked " to the minute " , e. g. 20 min, or 35

minutes, while HCPCs are in 15 minute " Mods " . or without time frames.

This leads to a disparity in the same patient as to the PPS minutes and

the HCPC charges.

Any suggestions would be greatly appreciated.

Thanks!

___________________________________________________________________

You don't need to buy Internet access to use free Internet e-mail.

Get completely free e-mail from Juno at http://www.juno.com

or call Juno at (800) 654-JUNO [654-5866]

______________________________________________________________________

2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

NextCard Internet VISA has a great introductory APR.

Customers with good credit are eligible for this special rate.

No tricks, no gimmicks - just a great rate for Internet customers!

http://ads./click/63/1/nextcard

[Guest guest]

That's the way we interpret it!

>>> Tina Rosier 10/14 8:56 AM >>>

We are developing a " Daily Treatment record " that includes:

Start and stop time of visit

Date, therapist signature

Charge for treatment

and a note on the treatment rendered.

I think that this will address everything that we need to document to

support the MDS and state regs.

As far as CPTs go, my understanding is that for the ones that are

defined by 15 minutes of treatment: that this means 1-15 minutes of that

procedure. So, if my therapist did 25 minutes of gait and 10 minutes of

therapeutic exercise: they would charge (2) gait and (1) ther ex.

Any other interpretations would be appreciated.

TIna

Indpls, IN

>>> Rich 10/14/98 05:43pm >>>

Any suggestions as to how to track PPS minutes and HCPCS

charges

in one sheet for a subacute unit in a LTC facility? My understanding is

that PPS minutes are tracked " to the minute " , e. g. 20 min, or 35

minutes, while HCPCs are in 15 minute " Mods " . or without time frames.

This leads to a disparity in the same patient as to the PPS minutes and

the HCPC charges.

Any suggestions would be greatly appreciated.

Thanks!

___________________________________________________________________

You don't need to buy Internet access to use free Internet e-mail.

Get completely free e-mail from Juno at http://www.juno.com

or call Juno at (800) 654-JUNO [654-5866]

______________________________________________________________________

2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

NextCard Internet VISA has a great introductory APR.

Customers with good credit are eligible for this special rate.

No tricks, no gimmicks - just a great rate for Internet customers!

http://ads./click/63/1/nextcard

[Guest guest]

As would I. Every PT manager and business consultant seems to have their own

*respectfully* ........interpretation of how to use the codes correctly. We

charge as Sandy does and this is the way our administration/finance department

is advising us. [that does not mean -necessarily- that it is correct] I, too,

am looking for some written guidance on this issue.

In addition, one other similar place we are getting confusing guidance and

messages is in the issue of co-treatment. In my career I have always

co-treated in clinically appropriate situations.

At my current position, we co treat frequently in pediatrics when necessary,

and we co-eval/team eval in rehabilitation to avoid duplication by the patient

and to allow us to efficiently generate co-hesive team goals. Our finance

people adamantly refuse to allow us to charge separately - i.e. if the session

is one hour and each discipline is working on their specific objectives and

documenting the same, he wants outside PROOF that PT can charge 1 hour and OT

1 hour.

Again, I would be interested in the stance of other clinics, their practice,

documentation, codes, etc.

I would love some guidance. Sometimes it is tough as a clinician when you know

something is clinically the 'right thing to do' but, business wise, you have to

defend your position.

Thank you in advance for your time.

Sandy McCuen wrote:

> Tina Rosier wrote:

> >

> > We are developing a " Daily Treatment record " that includes:

> > Start and stop time of visit

> > Date, therapist signature

> > Charge for treatment

> > and a note on the treatment rendered.

> > I think that this will address everything that we need to document to

> > support the MDS and state regs.

> >

> > As far as CPTs go, my understanding is that for the ones that are

> > defined by 15 minutes of treatment: that this means 1-15 minutes of that

> > procedure. So, if my therapist did 25 minutes of gait and 10 minutes of

> > therapeutic exercise: they would charge (2) gait and (1) ther ex.

> >

> > Any other interpretations would be appreciated.

> > TIna

> > Indpls, IN

> >

> > >>> Rich 10/14/98 05:43pm >>>

> > Any suggestions as to how to track PPS minutes and HCPCS

> > charges

> > in one sheet for a subacute unit in a LTC facility? My understanding is

> > that PPS minutes are tracked " to the minute " , e. g. 20 min, or 35

> > minutes, while HCPCs are in 15 minute " Mods " . or without time frames.

> > This leads to a disparity in the same patient as to the PPS minutes and

> > the HCPC charges.

>

> > Any suggestions would be greatly appreciated.

> >

> > Thanks!

> >

> >

>

> Hi ,

>

> It is my impression that you must aggregate timed exercise type units

> and bill only for the total one on one exercise time regardless of the

> number of exercise procedures provided. For example a patient completed

> 10 minutes of gait, 10 minutes of ther ex and 10 minutes of neuro

> muscular reed. the total time is 30 minutes and you can only bill 2

> units. All procedures would be documented, but only two would be

> recognized on the bill. I would like your method to be right, but am

> doubtful.

>

> Looking for response,

>

> Sandy

> > ___________________________________________________________________

> > You don't need to buy Internet access to use free Internet e-mail.

> > Get completely free e-mail from Juno at http://www.juno.com

> > or call Juno at (800) 654-JUNO [654-5866]

> > ______________________________________________________________________

> > 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

> > NextCard Internet VISA has a great introductory APR.

> > Customers with good credit are eligible for this special rate.

> > No tricks, no gimmicks - just a great rate for Internet customers!

> > http://ads./click/63/1/nextcard

> >

> >

[Guest guest]

Tina Rosier wrote:

>

> We are developing a " Daily Treatment record " that includes:

> Start and stop time of visit

> Date, therapist signature

> Charge for treatment

> and a note on the treatment rendered.

> I think that this will address everything that we need to document to

> support the MDS and state regs.

>

> As far as CPTs go, my understanding is that for the ones that are

> defined by 15 minutes of treatment: that this means 1-15 minutes of that

> procedure. So, if my therapist did 25 minutes of gait and 10 minutes of

> therapeutic exercise: they would charge (2) gait and (1) ther ex.

>

> Any other interpretations would be appreciated.

> TIna

> Indpls, IN

>

> >>> Rich 10/14/98 05:43pm >>>

> Any suggestions as to how to track PPS minutes and HCPCS

> charges

> in one sheet for a subacute unit in a LTC facility? My understanding is

> that PPS minutes are tracked " to the minute " , e. g. 20 min, or 35

> minutes, while HCPCs are in 15 minute " Mods " . or without time frames.

> This leads to a disparity in the same patient as to the PPS minutes and

> the HCPC charges.

> Any suggestions would be greatly appreciated.

>

> Thanks!

>

>

Hi ,

It is my impression that you must aggregate timed exercise type units

and bill only for the total one on one exercise time regardless of the

number of exercise procedures provided. For example a patient completed

10 minutes of gait, 10 minutes of ther ex and 10 minutes of neuro

muscular reed. the total time is 30 minutes and you can only bill 2

units. All procedures would be documented, but only two would be

recognized on the bill. I would like your method to be right, but am

doubtful.

Looking for response,

Sandy

> ___________________________________________________________________

> You don't need to buy Internet access to use free Internet e-mail.

> Get completely free e-mail from Juno at http://www.juno.com

> or call Juno at (800) 654-JUNO [654-5866]

> ______________________________________________________________________

> 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

> NextCard Internet VISA has a great introductory APR.

> Customers with good credit are eligible for this special rate.

> No tricks, no gimmicks - just a great rate for Internet customers!

> http://ads./click/63/1/nextcard

>

>

[Guest guest]

You wrote:

>It is my impression that you must aggregate timed exercise type units

>and bill only for the total one on one exercise time regardless of the

>number of exercise procedures provided. For example a patient completed

>10 minutes of gait, 10 minutes of ther ex and 10 minutes of neuro

>muscular reed. the total time is 30 minutes and you can only bill 2

>units. All procedures would be documented, but only two would be

>recognized on the bill. I would like your method to be right, but am

>doubtful.

I don't think your conclusion above is correct. As long as you use the CPT

time definitions correctly, then you could very well spend only 30 minutes

of time with a patient but still charge 3 CPT codes. Your description above

is a perfect example of just such a scenario, but instead billing all three

units (CPT codes 97116 = gait, 97110 = ther. ex., and 97112 = muscle re-ed).

We currently charge for all three units charged. I would say, however, that

if this occurs frequently you had better be sure that your documentation

backs up these charges in case Medicare auditors come a calling! (fun, fun)

Mark Dwyer, MHA, PT

Manager of Rehabilitation Services

mdwyer1@...

______________________________________________________________________

2X 2X 2X DOUBLE REWARDS POINTS! 2X 2X 2X

Open a new NextCard Internet Visa account with a

qualifying balance transfer and you'll earn DOUBLE

Rewards points. Earn free airline tickets in half the

time! Intro rates as low as 2.9% APR and NO annual fee!

Apply Online NOW!

http://ads./click/63/0/nextcard

[Guest guest]

Marcia,

I have been advised to charge only for the TOTAL time the therapists spent

with the patient. So if the co-treat was for 60 minutes and it involved a

PT and an OT, then the most that can be charged by BOTH disciplines is 60

minutes. Usually we just take a 50/50 split and each discipline charges for

a half hour.

Mark Dwyer, MHA, PT

Manager of Rehabilitation Services

mdwyer1@...

Re: HCPCS coding and PPS tracking -Reply

>As would I. Every PT manager and business consultant seems to have their

own

>*respectfully* ........interpretation of how to use the codes correctly.

We

>charge as Sandy does and this is the way our administration/finance

department

>is advising us. [that does not mean -necessarily- that it is correct] I,

too,

>am looking for some written guidance on this issue.

>

>In addition, one other similar place we are getting confusing guidance and

>messages is in the issue of co-treatment. In my career I have always

>co-treated in clinically appropriate situations.

>At my current position, we co treat frequently in pediatrics when

necessary,

>and we co-eval/team eval in rehabilitation to avoid duplication by the

patient

>and to allow us to efficiently generate co-hesive team goals. Our finance

>people adamantly refuse to allow us to charge separately - i.e. if the

session

>is one hour and each discipline is working on their specific objectives and

>documenting the same, he wants outside PROOF that PT can charge 1 hour and

OT

>1 hour.

>Again, I would be interested in the stance of other clinics, their

practice,

>documentation, codes, etc.

>I would love some guidance. Sometimes it is tough as a clinician when you

know

>something is clinically the 'right thing to do' but, business wise, you

have to

>defend your position.

>Thank you in advance for your time.

>

>

>Sandy McCuen wrote:

>

>> Tina Rosier wrote:

>> >

>> > We are developing a " Daily Treatment record " that includes:

>> > Start and stop time of visit

>> > Date, therapist signature

>> > Charge for treatment

>> > and a note on the treatment rendered.

>> > I think that this will address everything that we need to document to

>> > support the MDS and state regs.

>> >

>> > As far as CPTs go, my understanding is that for the ones that are

>> > defined by 15 minutes of treatment: that this means 1-15 minutes of

that

>> > procedure. So, if my therapist did 25 minutes of gait and 10 minutes

of

>> > therapeutic exercise: they would charge (2) gait and (1) ther ex.

>> >

>> > Any other interpretations would be appreciated.

>> > TIna

>> > Indpls, IN

>> >

>> > >>> Rich 10/14/98 05:43pm >>>

>> > Any suggestions as to how to track PPS minutes and HCPCS

>> > charges

>> > in one sheet for a subacute unit in a LTC facility? My understanding

is

>> > that PPS minutes are tracked " to the minute " , e. g. 20 min, or 35

>> > minutes, while HCPCs are in 15 minute " Mods " . or without time frames.

>> > This leads to a disparity in the same patient as to the PPS minutes and

>> > the HCPC charges.

>>

>> > Any suggestions would be greatly appreciated.

>> >

>> > Thanks!

>> >

>> >

>>

>> Hi ,

>>

>> It is my impression that you must aggregate timed exercise type units

>> and bill only for the total one on one exercise time regardless of the

>> number of exercise procedures provided. For example a patient completed

>> 10 minutes of gait, 10 minutes of ther ex and 10 minutes of neuro

>> muscular reed. the total time is 30 minutes and you can only bill 2

>> units. All procedures would be documented, but only two would be

>> recognized on the bill. I would like your method to be right, but am

>> doubtful.

>>

>> Looking for response,

>>

>> Sandy

>> > ___________________________________________________________________

>> > You don't need to buy Internet access to use free Internet e-mail.

>> > Get completely free e-mail from Juno at http://www.juno.com

>> > or call Juno at (800) 654-JUNO [654-5866]

>> > ______________________________________________________________________

>> > 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

>> > NextCard Internet VISA has a great introductory APR.

>> > Customers with good credit are eligible for this special rate.

>> > No tricks, no gimmicks - just a great rate for Internet customers!

>> > http://ads./click/63/1/nextcard

>> >

>> >

[Guest guest]

In regards to the debate about the CPT codes and the 15 minute descriptor=

attached to most of them, I offer this perspective of the interpretation =

of

how to describe your PT and OT interventions;

Per the AMA's CPT editorial panel and its' advisory panels, specifically

the CPT Health Care Professionals Advisory Panel on which I sit and

represent APTA, ( Botten is the AOTA representative) the

interpretation of the " each 15 minute " descriptor on the majority of the

97000 series codes is that it represents a total of 15 minutes of service=

provided to the patient. It is not to be interpreted as describing " from=

1

to 15 minutes " as stated in a previous message. An example of applying

this application would be as follows;

A patient receives 20 minutes of therapeutic exercise for strengthening

(97110) followed by 6 minutes of ultrasound. This adds up to a total of =

26

minutes. Because each unit represents pre, intra, and post service time,=

which would represent in addition to your actual direct contact with the

patient (in the case of ther ex, the PT performing MRE's, PRE's, or

whatever)...the time it took to prepare the patient for the intervention,=

as well as the time it took you to document the intervention and discharg=

e

from the treatment, both the 20 minutes of ther ex (direct contact or int=

ra

service time) and the US(6 minutes of direct contact, intra service time)=

would have attached to it the pre and post service time that are part of

the service provided as described through the CPT code. To code for two

units of Ther. Ex and one unit of US would be appropriate in this scenari=

o,

because that would better describe the entire service provided, not just

the 20 minutes of " direct contact " , but also the time to get the patient

ready to do the exercise (demonstrating , seeing if they are able to foll=

ow

the directions, positioning them properly, etc.) and the time to get the=

m

discharged from the service (answering any questions, repositionining so

they can dress, documentation, etc.). When planning the delivery of your=

services and coding your services it is best to keep this in mind and als=

o

keep in mind that your documentation must support the codes (and number o=

f

units for each code that has a time descriptor) billed. If two units of

ther ex is billed and the documentation demonstrates;

" patient received ther ex for Left knee, including PRE's and squats " tha=

t

does not adequately support billing for 30 minutes of ther ex. A better

note would say, " patient rcvd ther ex for strengthening of the quadriceps,=

reporting prev trtnmt left some discmfort lat.joint, noted no swelling. =

Pre's up to 15#/ 10 reps X 5, SLR, TKE, folllowed by squats with 30 sec

hold at approx 45 degree's, 5 reps/ 10 sets,worked specifically on

endurance activities in addition to strengthening MRE's, high reps low

resistance, pt tol. 20 minutes of execises with pt noting less c/o

discomfort lateral to joint, ended treatment with instruction for home an=

d

reviewed plan for next visit. "

Tacking on units solely for the purpose of describing documentation of th=

e

services is inappropriate because the pre and intra service time is not

represented....The pre, intra and post service time together describe the=

intervention, via the CPT code and also figure importantly in determining=

the value of the " work " provided in the delivery of that service.

This way of looking at time in the delivery of services when paid under t=

he

fee schedule is entirely different then how time is considered when under=

PPS. Unfortunately, if you are a therapist who works under both payment

methodolgies, it will be a bit confusing but may help if you understand t=

he

basics about the time component of each payment method. =

There are modifiers in the CPT system that are available to modify a code=

that you bill describing a service when the service actually provided is

less than what the code describes, for example if a patient becomes ill i=

n

the middle of a treatment ....but since the timed PM & R codes are in 15

minute units, with the exception of WH/WC, this modifier is not used oft=

en

(modifier 52, found in appendix A, CPT book)..Modifiers are often not

recognized well by the payers, so I would check with your billing dept.s =

in

terms of the best application...

As I started out saying this is the interpretation from the AMA and it's

editorial and advisory panels. In other words if payers ask this questio=

n

this is the answer they will most likely receive!

In regards to co-treatment. The only reason you should not code separate=

ly

for your services, is if both you and the OT are working under the same

plan of care to acheive the same set of functional goals. A PT coding

for ther ex and an OT coding for ther ex could describe very different

applications of that intervention, thus supporting the use of the CPT cod=

e

to describe each of their services with different plans to reach their

goals. =

Helene M. Fearon, PT

AMA-CPT HCPAC

______________________________________________________________________

2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9% 2.9%

NextCard Internet VISA has a great introductory APR.

Customers with good credit are eligible for this special rate.

No tricks, no gimmicks - just a great rate for Internet customers!

http://ads./click/63/1/nextcard