RE: Re: Billing and coding for a client with three distinct problems that need evaluation and treatment

[Guest guest]

Hi Tim,

With respect, my post was not about treatment but about how to code and bill

properly. This patient is being seen, once the evaluations are complete,

with treatment in mind that takes into account the whole person. I agree

with your sentiments and that they needed to be stated but I also think that

clients can come see us that have totally unrelated separate and distinct

problems that do not necessarily have to be addressed at the same time.

I also posted my request taking in mind that while I treat a certain way and

do so not based on what insurance dictates as much as possible, I also have

to be mindful that insurances require me to code and bill in precise ways.

I have no illusion that this case will probably go to appeal but if we code

and bill our services the correct way, it will limit future problems with

those appeals and may even prevent them.

By the way, in this case, creating three separate cases actually is easier

in our system; however, it is very rare that we ever have to do it.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

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_____

From: PTManager [mailto:PTManager ] On Behalf

Of medicalartsrehab

Sent: Thursday, June 10, 2010 3:57 PM

To: PTManager

Subject: Re: Billing and coding for a client with three distinct

problems that need evaluation and treatment

Tom, Diane and Ron,

It makes no sense to treat ONE patient with three " diagnoses " , three evals

and three charts or even separate visits. You are treating the person - not

the diagnosis.

Your rehabilitative diagnosis is based on what the person can and cannot do

(eg: sit-to-stand, walking, rolling over in bed) and your interventions

should derive from these findings.

You may find that the separate pathologic diagnoses each contribute to one

or more activity limitation, such as knee OA and spinal stenosis both

limiting walking - but your interventions still just address walking.

Commercial payers (except Work Comp) have administrative edits to prevent

over-utilization. They pretty much don't care what you do within your scope

of practice (some states have " diagnostic crosswalks " - matched CPT and

ICD-9 edits that prevent payment such as electrical nerve stimulation for

facial nerve (Bell's) palsy).

Medicare wants you to maximize function at minimum cost and you just need to

get a physician (for now) to sign your Plan of Care - you could probably put

headache and great toe pain on the same POC if you could show that these

impairments limit patient function or jeopardize safety.

Use of validated patient self-reports, performance measures, psychosocial

measures and decision rules greatly reduce the anxiety of physical therapist

decision making in complex situations such as this.

Anxiety leads to poor clinical decisions, like creating three charts, three

appointments and three diagnoses for ONE patient.

Tim , PT

www.PhysicalTherapyDiagnosis.com

>

>

>

> Subject: Re: Billing and coding for a client with three

distinct problems that need evaluation and treatment

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Date: Wednesday, June 9, 2010, 9:15 PM

>

>

> Â

>

>

>

> ,

> My recommendation would be to separate appts into 3 distinct appts--bill

accordingly as if he was 3 diff pts---with 3 diff charts---that is what I

would do and then you link those respective charges to the respective dx

you are treating. That is what we do and works fine ---just alot of paper

work to track--but seems to works well

> Â

> Ron Masri, PT, DPT,OCS, ATC

> Total Motion Physical Therapy

> Owner

> www.totalmotionpt.net

>

> Â

> Â

>

> ________________________________

>

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Sent: Wed, June 9, 2010 6:18:53 PM

> Subject: Billing and coding for a client with three distinct

problems that need evaluation and treatment

>

> Â

> Hi everyone,

>

> Been a while since we had this kind of case and wanted to confirm how this

> would be coded and billed:

>

> Pt. referred for three separate and distinct mostly unrelated problems

that

> have all flared up or failed recent other typed of treatment basically at

> the same time.

>

> Pt will have three separate evaluations, most likely at separate visits.

> How should we bill these? Same case? Different cases? Modifiers?

>

> For treatment, may be treating all three problems in the same day. We've

> used the -59 modifier appropriately in the past but now my biller is

citing

> denials of this from our insurance. Insurance is Federal BC/BS

administered

> locally by Blue Cross of Idaho. How would you recommend that we code and

> bill treatment.

>

> Thanks for you help on this.

>

> Tom Howell, P.T., M.P.T.

>

> Howell Physical Therapy

>

> Eagle, ID

>

> thowell@...

>

> This email and any files transmitted with it may contain PRIVILEGED or

> CONFIDENTIAL information and may be read or used only by the intended

> recipient. If you are not the intended recipient of the email or any of

its

> attachments, please be advised that you have received this email in error

> and that any use, dissemination, distribution, forwarding, printing or

> copying of this email or any attached files is strictly prohibited. If you

> have received this email in error, please immediately purge it and all

> attachments and notify the sender by reply email.

>

>