Guest guest Posted March 5, 2006 Report Share Posted March 5, 2006 Hello to the group! I'm having trouble figuring out how to bill for the following services: Ther Ex - 97110 = 35 min Muscle Re-ed - 97112 = 10 min Gait Tr - 97116 = 4 min Ultrasound - 97035 = 6 min Ther Massage - 97124 = 3 min Ther Act - 97530 = 2 min This is for Medicare Part B (outpatient). I know I can bill for 2 Units of 97110 and 1 Unit of 97112. But how about the remaining of the procedures? According to Medicare " providers should not bill for services performed < 8 minutes " . However the total treatment time was 60 minutes, which should entitle me to 4 Units of charge. Right? I would appreciate if anyone could jump in to help. Corneau, PT North Hills, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2006 Report Share Posted March 5, 2006 , You are correct in that you could bill for 4 units. I would question the small amount of time you spent on several procedures, but that is another subject. The correct billing (in my opinion) would be 2 units 97110, 1 unit 97112, and 1 unit 97035 since those were the procedures you spent the most time on. We are awaiting CMS to release some more examples on billing much like you describe and their answers may surprise some of us. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital HPA Government Affairs & Practice Committee --- ncorneau wrote: > Hello to the group! > > I'm having trouble figuring out how to bill for the > following services: > Ther Ex - 97110 = 35 min > Muscle Re-ed - 97112 = 10 min > Gait Tr - 97116 = 4 min > Ultrasound - 97035 = 6 min > Ther Massage - 97124 = 3 min > Ther Act - 97530 = 2 min > > This is for Medicare Part B (outpatient). > I know I can bill for 2 Units of 97110 and 1 Unit of > 97112. But how > about the remaining of the procedures? According to > Medicare " providers > should not bill for services performed < 8 minutes " . > However the total > treatment time was 60 minutes, which should entitle > me to 4 Units of > charge. Right? > I would appreciate if anyone could jump in to help. > > Corneau, PT > North Hills, CA > > > > > > > > > Please identify yourself, your discipline and your > location in all posts to PTManager > > Looking to start and own 100% of your own Practice? > > Visit www.InHomeRehab.com. > PTManager encourages participation in your > professional association. Join and participate now! > > Please identify yourself in all postings to > PTManager. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2006 Report Share Posted March 5, 2006 There must be a lot of clock watching or bells going off. Do you really feel that 4 minutes of gait training, 6 minutes of ultrasound, 3 minutes of massage and 3 minutes of Ther. Act. somewhere in between the other listed 45 minutes, is effective treatment? Norton, PT ncorneau wrote: Hello to the group! I'm having trouble figuring out how to bill for the following services: Ther Ex - 97110 = 35 min Muscle Re-ed - 97112 = 10 min Gait Tr - 97116 = 4 min Ultrasound - 97035 = 6 min Ther Massage - 97124 = 3 min Ther Act - 97530 = 2 min This is for Medicare Part B (outpatient). I know I can bill for 2 Units of 97110 and 1 Unit of 97112. But how about the remaining of the procedures? According to Medicare " providers should not bill for services performed < 8 minutes " . However the total treatment time was 60 minutes, which should entitle me to 4 Units of charge. Right? I would appreciate if anyone could jump in to help. Corneau, PT North Hills, CA Please identify yourself, your discipline and your location in all posts to PTManager Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Please identify yourself in all postings to PTManager. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2006 Report Share Posted March 5, 2006 ; Technically you are not able to bill for each of your skilled services. The point I think you're trying to bring out is that there could be two ways to bill activity / exercise and get paid less for the same amount of work if it were billed differently. The only way you would be able to bill for an " unit " of therex, neuro-musc re-ed, and functional activty, etc.. would be to do enough of the required amount,8 to 15 minutes, and then bill each code. The problem is that it is my assumption that you can't bill more than 60 minutes worth of activty. This brings me to my next question. Is billing more than 60 minutes worth of therapy services allowable if you do 1.5 hrs of 97110 or any other combination over a 60 minute treatment session? And if so, is insurance reimbursing it? I have seen limits on the patient's benefits that state you can not bill more than " x " number of units. I have not limited patients to the amount of service they need in a given treatment session based on their insurance coverage. The reason I bring this up is because I am assuming there are a lot of conscientous therapists out there that do more than what they are allowed to be reimbursed for. For example you may treat a patient with poor reimbursement rates to an ability of yours that exhausts your own skills and get reimbursed 1 third the amount that another insurance company reimburses for the skills that you find very easy based on a low intensity / severity of injury requiring physical therapy services. The problem comes in that many more patients seem to be covered by the insurance companies that reimburse the least. Anyone else noticing this??? I'm interested to hear the regular responders opinions either on or off-list. Take care, Zerr, PT Summit Physical Therapy Date: 2006/03/05 Sun PM 06:23:24 PST To: PTManager Subject: Billing Question Hello to the group! I'm having trouble figuring out how to bill for the following services: Ther Ex - 97110 = 35 min Muscle Re-ed - 97112 = 10 min Gait Tr - 97116 = 4 min Ultrasound - 97035 = 6 min Ther Massage - 97124 = 3 min Ther Act - 97530 = 2 min This is for Medicare Part B (outpatient). I know I can bill for 2 Units of 97110 and 1 Unit of 97112. But how about the remaining of the procedures? According to Medicare " providers should not bill for services performed < 8 minutes " . However the total treatment time was 60 minutes, which should entitle me to 4 Units of charge. Right? I would appreciate if anyone could jump in to help. Corneau, PT North Hills, CA Please identify yourself, your discipline and your location in all posts to PTManager Looking to start and own 100% of your own Practice? Visit www.InHomeRehab.com. PTManager encourages participation in your professional association. Join and participate now! Please identify yourself in all postings to PTManager. Quote Link to comment Share on other sites More sharing options...
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