Eval Code Billing Questions

[Guest guest]

Dear Colleagues:

I recently encountered an Alabama hospital charge master with different

" levels, " (charges increasing with time) for CPT codes 97001 and 2. The reason

given for the different levels is to track therapist productivity. The different

charges drop for the different levels of service. Call me someone who has

difficulty think outside the box, but aren't 97001 and 2 un-timed codes? Also,

can you charge differing amounts for the same CPT code? References or links to

answer the above would be appreciated.

Greg Weiland, MBA, PT, CEAS, CIR

[Guest guest]

Greg - The hospital billing system probably drops the change on to the bill

as an untimed code (1 unit), and probably also lists the expected payment

per the contract for hospital projected reimbursement. By having the

" input " side track time, the system is able to record therapist time for

other purposes such as productivity.

This is not unusual, and I have seen this in a lot of hospital charge

masters. Same concept of suppressing the 97010 charge (heat/ice) on the

bill for payors that don't pay for it, such as Medicare.

Beckley, MS, MBA, CHC

Certified Healthcare Compliance

www.BloomingdaleConsulting.com

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Greg Weiland

Sent: Monday, July 28, 2008 9:40 PM

To: PTManager

Subject: Eval Code Billing Questions

Dear Colleagues:

I recently encountered an Alabama hospital charge master with different

" levels, " (charges increasing with time) for CPT codes 97001 and 2. The

reason given for the different levels is to track therapist productivity.

The different charges drop for the different levels of service. Call me

someone who has difficulty think outside the box, but aren't 97001 and 2

un-timed codes? Also, can you charge differing amounts for the same CPT

code? References or links to answer the above would be appreciated.

Greg Weiland, MBA, PT, CEAS, CIR

[Guest guest]

Greg,

Your confusing charges with reimbursement. You can charge anything you like,

but your contract or fee schedule determine what you will get paid.

" Todd " Freeman

ville, TN

Eval Code Billing Questions

Dear Colleagues:

I recently encountered an Alabama hospital charge master with different

" levels, " (charges increasing with time) for CPT codes 97001 and 2. The reason

given for the different levels is to track therapist productivity. The different

charges drop for the different levels of service. Call me someone who has

difficulty think outside the box, but aren't 97001 and 2 un-timed codes? Also,

can you charge differing amounts for the same CPT code? References or links to

answer the above would be appreciated.

Greg Weiland, MBA, PT, CEAS, CIR

[Guest guest]

Greg, I am familiar with a hospital system that has the same eval breakdown,

it does put a " value " on the time spent on an eval, whether it be brief or

lengthy. It is used for productivity as well as establishing the " cost " of

providing care.

Jeff Wheeler PT, GCS

Highline Medical Ctr

Tukwila, WA

Eval Code Billing Questions

Dear Colleagues:

I recently encountered an Alabama hospital charge master with different

" levels, " (charges increasing with time) for CPT codes 97001 and 2. The

reason given for the different levels is to track therapist productivity.

The different charges drop for the different levels of service. Call me

someone who has difficulty think outside the box, but aren't 97001 and 2

un-timed codes? Also, can you charge differing amounts for the same CPT

code? References or links to answer the above would be appreciated.

Greg Weiland, MBA, PT, CEAS, CIR