Re: Digest Number 1416

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Question: We have a patient being seen for her shoulder (2x/week) and she

was just given a prescription to come in for pool therapy to neck/back

(3x/week). My question is this: Will Medicare pay for 2 separate appts

for the same day (clinic for shoulder treatment and then pool later that

day for other diagnoses) or would I be better off telling the patient she

needs to come in 5x/week?

Answer: You have a choice. If she is being seen somewhere else for her

shoulder, I doubt Medicare will pay for her to attend therapy at 2

different PT clinics during the same timeframe. However, if she is already

being seen within your facility for her shoulder, the following should be

true:

1. You can bill her for an aquatic therapy session(97113) on the same day

as her land treatment as long as her land therapists attach the -59

modifier to her billing codes (97110, etc.), so that it is evident that

her treatment is being performed separately.

2. If you use " normal " CPT codes (e.g. 97110, 97112) to describe aquatic

therapy instead of the 97113 code, then you can just combine the units

from land and water and let your documentation show " what " happened

" where " . Many clinics do not use the 97113 code to describe aquatic

therapy. There are arguments on why you should and why you shouldn't use

97113 -- but they are much too complicated to go into here. Suffice it to

say that it is fine in most situations to use 97110 (for example) to

describe aquatic therapy as long as this is your common practice and you

are not doing it to " skirt " payment problems.

That said, this " land for one diagnosis " and " sea for another diagnosis "

arrangement is somewhat artificial. Usually, clinics will split treatments

over the course of a week. For example, a patient in acute pain may be

seen initially 3x/week in the water, then 2x/week in the water and 1x/week

on land, then join an aquatic class and continue with land-based therapy

as needed.

Salzman, MS, PT

Aquatic Resources Network

302 160th Street -- Suite 200

Amery, Wisconsin 54001 USA

Ph:

Fax:

E-mail: asalzman@...

Web: www.aquaticnet.com