RE: Proper billing for US/stim combo

[Guest guest]

Mark,

Total 1-on-1 treatment time is 35 minutes. According to Medicare you can

bill 2 units (and we bill everyone the same). We were told by our Medicare

intermediary to bill an ultrasound unit for US/HV Estim (versus an attended

e-stim), but that is debatable. There is no specific code for US/HV Estim.

In my clinic, I would encourage my staff to bill 1 unit of Ther-Ex and 1

unit of Manual Therapy, and leave out the US because it has the lowest

reimbursement.

That's my understanding and views,

Normington PT, DPT

Doctor of Physical Therapy

Director Physical Medicine/Rehabilitation

Cherokee Regional Medical Center

300 Sioux Valley Drive

Cherokee, IA. 51012

phone

fax

_____

From: PTManager [mailto:PTManager ] On Behalf

Of ms3andc

Sent: Monday, July 24, 2006 9:10 PM

To: PTManager

Subject: Proper billing for US/stim combo

Hi group. I was wondering what the proper Medicare coding is for a

treatment consisting of 10 min US/HV Estim combination,10 min HP, 10

min deep tissue work and 15 min stretching. I'm not sure of the CPT

code for the combo or if there even is one. . .I had billed US and 1

unit ther ex.

Thank you,

Mark Milleville PT

Wheatfield Physical Therapy

Wheatfield, NY

[Guest guest]

Hi, Mark -

You're right to recognize that what we sell these days is... Time. A combo

treatment only takes one bolus of time.

Two factors are at work here: Time constraints on each component of the

visit, and a time constraint on the total visit. The total units charged

for a visit may not legitimately be for more time than the visit actually

took.

There is no CPT Code for the combination of US and Estim, so you would be

justified in identifying and documenting which one which best addresses what

you're trying to achieve in that 10 minute period: heating or the

physiological effects of the stim you're applying. Choosing for the effect

on the patient's condition is appropriate. But, in case you had a former

employer who told you to just charge whichever pays the highest, that would

be inappropriate.

Medicare has told us all that we are not to charge for Hot or Cold Pack

because they've included a few cents for that in every other service we

charge for, so HP is out of the calculation.

10 min - CPT 97035 (US) or G0283 (Estim not wound care)

10 min - CPT 97110 (TherEx)

10 min - CPT 97140 (Manual therapy)

....For a total of 30 chargeable minutes in the visit, since they're all

timed charges. That's enough for the Manual therapy (CPT-97140) and

Therapeutic exercise (CPT-97110). Something in addition to the HP is going

to have to be left out of the billing because of the 30 minute constraint.

Since you're doing a 40 minute visit, could the patient appropriately gain

from added TherEx to generate the heat which you were going to get from the

HP? (Not to mention the increased uptake of glucoaminoglycans to promote

flexibility!) If so, you'd be charging for 2 units of Therex and 1 of

manual therapy.

Hope that helps!

Dick Hillyer, PT, MBA, MSM

Hillyer Associates

700 El Dorado Pkwy West

Cape Coral, FL 33914

Dick@...

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Mobile

Proper billing for US/stim combo

Hi group. I was wondering what the proper Medicare coding is for a

treatment consisting of 10 min US/HV Estim combination,10 min HP, 10 min

deep tissue work and 15 min stretching. I'm not sure of the CPT code for the

combo or if there even is one. . .I had billed US and 1 unit ther ex.

Thank you,

Mark Milleville PT

Wheatfield Physical Therapy

Wheatfield, NY

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[Guest guest]

I was taught in a billing seminar that there is no code for Combo. I was told

that you have to either bill it as US or as Estim. What I normally do, is do a

combo and bill it as US and then I do an extra 10 or 15 minutes of Estim.

TrVera

Serenity Rehab and Wellness Center

Proper billing for US/stim combo

Hi group. I was wondering what the proper Medicare coding is for a

treatment consisting of 10 min US/HV Estim combination,10 min HP, 10

min deep tissue work and 15 min stretching. I'm not sure of the CPT

code for the combo or if there even is one. . .I had billed US and 1

unit ther ex.

Thank you,

Mark Milleville PT

Wheatfield Physical Therapy

Wheatfield, NY

Please identify yourself, your discipline and your location in all messages to

PTManager.

Sick of working for someone else?

Tired of fighting against POPTS?

Ready to quit the corporate nonsense of large organizations?

Visit www.InHomeRehab.com.

PTManager encourages participation in your professional association. Join APTA,

AOTA or ASHA and participate now!

Please identify yourself, your discipline and your location in all messages to

PTManager.