Group Code - groan

[Guest guest]

There still seems to be a lot of confusion in the industry related to using this

code. Two issues:

1. The CCI edits call for not reimbursing for the group code (97150) and a

therapeutic procedure like therapeutic exercise (97110) for a patient in the

same day. While carriers must implement this, are clinicians experiencing

fiscal intermediaries (in settings like hospital outpatient departments)

implementing these edits? Most FIs I have talked to have stated the only edit

they are implementing is the gait training - prosthetic training one. This, and

92507 and 97770 for cognitive therapy, were the only ones identified in

Transmittal AB-00-14.

2. Therapist works 1:1 with Patient A for 18 minutes, then sets patient up on

the mat to continue with therapeutic exercise. Then patient B is started 1:1

ther ex, visually overseeing patient A. Are both patient now group? Is

Patient A group and patient B ther ex? AMA 2000 descriptor states that group

code " involves constant attendance of the physician or therapist, but by

definition do not require one-on one patient contact by the physician or

therapist. "

Reese

GNA