Re: Digest Number 967

[Guest guest]

<<1 Licensed staff supervising 4-5 patients in the pool for one hour,

doing aquatic exercises: - The patients require minimal to no physical

assistance, but do

require the skill of a licensed therapist for verbal/visual or tactile

cures, as well as for proper technique and treatment progression, response

to treatment, etc. - How do most therapists bill this? Aquatic therapy 15

minutes x 4

for each patient 97113 or group therapy x 1 for each patient (97150) a

combination of the two or something different>>

Dear Jon,

The scenario described above is approximately the scenario HealthSouth

found itself in. HealthSouth was billing each patient using the 97113 code

(4 units per hour). Medicare has ruled that this is inappropriate and that

each patient should have been billed 1 unit (untimed code) of group

(97150). You cannot charge Medicare using the 97113 code if one staff

member is supervising more than one person during the same time period. And

since Medicare does not allow aides, the " staff member " must be a PT or a

PTA (under proper supervision).

Although not all insurers follow Medicare's rules religiously, all insurers

now use the CPT coding system. And if you read the CPT descriptors for all

of the 97XXX therapeutic procedures (with the exception of 97150), they all

require " direct 1:1 contact " . Read more at www.apta.org (click on Group

therapy link on main page).

Salzman, MS, PT

Aquatic Resources Network

302 160th Street -- Suite 200

Amery, Wisconsin 54001 USA

Ph:

Fax:

E-mail: asalzman@...

Web: www.aquaticnet.com

[Guest guest]

Each would be a group charge, unless there were 2 therapists in the pool

and one was providing one on one while the other was preforming group

proceedures. We often have 2 therapists in the pool for large groups and

each person gets at least 8 minutes of 1-on-1 and the remainder of time

group, then we charge an agua therapy 1 and a group charge. With on

therapist in the pool it is impossible to charge an 1-on-1 time.

Kathi Lee MS, PT

Carson City, MI