RE: When to charge an Eval and Re-eval

[Guest guest]

The APTA, CPT Coding and Medicare guidelines on documentation clearly

state when to use Evaluation versus Re-Evaluation. Whether a patient is

an inpatient or outpatient the initial assessment is the Evaluation.

Re-evaluation then occurs when a level of care change occurs or per the

documentation guidelines which are different for Inpatient versus

Outpatient. Re-evaluation should also not be confused with

re-assessment which occurs with each patient encounter. Insurance

reimbursement is a separate issue.

Hope this helps.

Ann O'Donnell

Director, Physical Medicine Department

Methodist Charlton Medical Center

3500 Wheatland Road

Dallas, Texas 75237

Office

Fax

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of mlavcavitt@...

Sent: Tuesday, July 27, 2010 9:59 AM

To: PTManager

Subject: When to charge an Eval and Re-eval

Dear Group,

I need some assistance. I have a client that only charges evals and

never

charges re-evals. I need some documentation to refer him to as I am

exhausted trying to explain to him why it is not appropriate to charge

an eval when

he is really performing a re-eval and/or his documentation supports a

re-eval.

Any help is greatly appreciated.

Have a great day.

D. Cavitt, President

Rehab Billing Specialists, LLC

Lafayette, LA 70506

[Guest guest]

Hi ,

If the client is an APTA member, there is a great FAQ section on the APTA

website with all needed information about evaluation and reevaluation. It

is in a members-only section and easily found by searching " reevaluation

FAQ " once logged in.

The other needed documents are the definitions and policy for Medicare

clients in the Medicare policy manuals (especially if treating Part B

Medicare) and the definitions of eval/reeval in the CPT codebooks.

One other factor is that there has to be some knowledge shared about what an

insurance will cover as well. As you know, many private insurers have

limits or their own contract rules that may supersede the normal defined use

of evals vs. reevals. It should be the responsibility of the billing

person, company or agent to keep open communication with the therapists as

to what these rules are as well and remind them, per client and per

insurance what the insurance contract says in regards to evals and reevals.

For instance, some insurers will limit the number of evaluations billed per

client per calendar year or limit the number of reevaluations allowed per

case. These are generally totally arbitrary limits used to deny the use of

codes that often have a good reimbursement. Like-it-or-not, it is

impossible for the therapist to remember all the nuances of each insurer and

where effective communication (maybe even a cheat -sheet) would come in

handy.

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.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of mlavcavitt@...

Sent: Tuesday, July 27, 2010 8:59 AM

To: PTManager

Subject: When to charge an Eval and Re-eval

Dear Group,

I need some assistance. I have a client that only charges evals and never

charges re-evals. I need some documentation to refer him to as I am

exhausted trying to explain to him why it is not appropriate to charge an

eval when

he is really performing a re-eval and/or his documentation supports a

re-eval.

Any help is greatly appreciated.

Have a great day.

D. Cavitt, President

Rehab Billing Specialists, LLC

Lafayette, LA 70506