Guest guest Posted January 4, 2011 Report Share Posted January 4, 2011 Happy New Year's To All, I have a client that proposed the following scenario to me: Patient A is being treated by Therapist A for low back pain and abnormality of gait. After performing 30 minutes of manual therapy, Patient A is sent into the gym for therapeutic exercise. Therapist A instructs Patient A on exercises and is called to the front office to take a telephone call. Therapist A leaves the gym for 5 minutes of Patient A's 24 minutes of therapeutic exercise. Simultaneously, Patient B is being treated by Therapist B in the gym for the same diagnosis, low back pain and abnormality of gait. Therapist B is supervising both Patient A and B while Therapist A is on a telephone call. Therapist A returns 5 minutes later and performs direct supervision of Patient A's remaining 14 minutes of therapeutic exercise. How should Therapist A bill Patient A, and why? Thank you in advance for your feedback. Vickie D. Cavitt, President Medical Legal Alliance, LLC 600 Guilbeau Road, Suite A Lafayette, LA 70506 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 5, 2011 Report Share Posted January 5, 2011 The math does not add up for Therapist A exercise portion of 24 minutes but phone call takes 5 minutes then bill for 14 minutes of ther ex. Where did the other 5 minutes go on the phone call? Linnea Olympia WA To: PTManager From: mlavcavitt@... Date: Tue, 4 Jan 2011 23:17:47 -0500 Subject: Billing Question Happy New Year's To All, I have a client that proposed the following scenario to me: Patient A is being treated by Therapist A for low back pain and abnormality of gait. After performing 30 minutes of manual therapy, Patient A is sent into the gym for therapeutic exercise. Therapist A instructs Patient A on exercises and is called to the front office to take a telephone call. Therapist A leaves the gym for 5 minutes of Patient A's 24 minutes of therapeutic exercise. Simultaneously, Patient B is being treated by Therapist B in the gym for the same diagnosis, low back pain and abnormality of gait. Therapist B is supervising both Patient A and B while Therapist A is on a telephone call. Therapist A returns 5 minutes later and performs direct supervision of Patient A's remaining 14 minutes of therapeutic exercise. How should Therapist A bill Patient A, and why? Thank you in advance for your feedback. Vickie D. Cavitt, President Medical Legal Alliance, LLC 600 Guilbeau Road, Suite A Lafayette, LA 70506 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 To bill the MMT CPT code of 95831 and ROM CPT code 95851, you must manually muscle test or take ROM of the entire extremity, not just one joint. Also, CPT code 97750, Physical Performance Test or Measurement, is not designed for ROM and MMT done by the therapist or assistant. 97750 is for a physical test or measurement performed by the patient under the direction of the therapist. Just taking ROM measurements and MMT of a joint is part of your assessment and is part of the CPT codes you are billing that day. For example, lets say you provide 20 minutes of manual therapy techniques on a patients right shoulder. Before beginning, you spend 2 minutes taking ROM measurements of the right shoulder and when done with the manual therapy techniques, you spend another 2 minutes taking ROM measurements to see the outcome of your techniques. When calculating the minutes of manual therapy, it would be 24 minutes as that assessment time is part of the manual therapy time. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Subject: RE: Billing question To: PTManager Date: Thursday, June 2, 2011, 10:29 PM Â Hi, Merle - Thanks for raising a pertinent issue! One very important issue is that one must only bill for the precise CPT Code which they actually perform. If the therapist performs Range of Motion Measurements and records their findings, then they may bill for range of motion measurement. If they also perform manual muscle testing, then they may bill for manual muscle testing. If they did not perform Manual Therapy techniques, they may not bill for manual therapy. When performing manual therapy techniques, one is constantly re-assessing and proceding as indicated, but this does not add billable CPT Codes to the visit. CPT 97002, Re-Evaluation is a separate process -- and a separate document. It is generally used when there has been a significant change in a patient's condition, such as when a hip fracture patient who had become able to walk 400 ft on a two wheeled walker on the sidewalk subsequently experiences seizures, the force of which re-opens a former PEG tube site, and has been on bed rest for a week. (This happened last month!) Re-eval is not a billing code to use casually, or just to write up a progress note to the physician for the patient's follow-up visit. It's a real evaluation of an existing, rather than new, patient. Organizations should check their charts intermittently and re-train its staff to: 1) Do the indicated procedure, 2) Document what they have done, and 3) Bill for exactly what they have done that they have documented. I once knew a DPM inTexas who combined the billing for two procedures which he *did* perform into a charge for one " sort of close " procedure which he *did not* actually perform. The insurance company took action against his license for fraud, and he was banned from Medicare program for five years. It's better to coach your staff (and owners, if necessary) to just do the right thing. Lawyers are far too costly! Hope that's useful! Dr. Dick Hillyer, PT Dr. Hillyer, PT,DPT,MBA,MSM Hillyer Consulting 700 El Dorado Pkwy W. Cape Coral, FL 33914 Mobile _____ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, June 02, 2011 3:45 PM To: PTManager Subject: Billing question Hello group, We had a patient call in to complain about her bill today. She stated that on two visits, she was billed manual therapy, 1 unit and never had any manual therapy during those visits. I checked back in the documentation (this is a non-Medicare patient, but our hospital requires us to bill all payers the same). On the first visit, the only thing documented in the chart were measurements of range of motion and manual muscle testing. Under subjective, the patient reported 95% pain relief and the therapist wrote in the assessment/plan " patient doing well, hold chart for 2 weeks- if no further complaints, d/c " ). The next and last visit was 2 weeks later. The patient had an exacerbation. There was more objective testing documented and some ther ex reviewed and modified. Here is what the therapist documented as far as billing: for Visit 1, she billed Manual Therapy, 15 minutes. For visit two, she billed Manual Therapy 20 minutes. My take is that since she can't bill re-eval for Visit 1, she was correct in her billing for that visit. However, she didn't bill for what she documented on Visit 2- her total time was 20 minutes (1 unit), but she didn't break it down by each procedure- it is unclear from her documentation as to which unit she spent more time. So question to the group- do you agree with how she billed? Any suggestions on a simple way to explain our very complicated billing system to a patient who has no clue? Thanks Meryl W. Freeman, MS PT Manager, Rex Hospital Outpatient Rehab (office) ----- Confidentiality Notice ----- This e-mail and any attached documents contain confidential information belonging to the sending entity, Rex Healthcare, and is intended only for the use of the individual(s) or entity(s) associated with the recipient addresses listed in the message header. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of the email and/or attachments is strictly prohibited. If you received this e-mail transmission in error, please notify the sender immediately to arrange for return or destruction of this information. To report abuse or inappropriate use, please email abuse@... <mailto:abuse%40rexhealth.com> .( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2011 Report Share Posted June 3, 2011 To bill the MMT CPT code of 95831 and ROM CPT code 95851, you must manually muscle test or take ROM of the entire extremity, not just one joint. Also, CPT code 97750, Physical Performance Test or Measurement, is not designed for ROM and MMT done by the therapist or assistant. 97750 is for a physical test or measurement performed by the patient under the direction of the therapist. Just taking ROM measurements and MMT of a joint is part of your assessment and is part of the CPT codes you are billing that day. For example, lets say you provide 20 minutes of manual therapy techniques on a patients right shoulder. Before beginning, you spend 2 minutes taking ROM measurements of the right shoulder and when done with the manual therapy techniques, you spend another 2 minutes taking ROM measurements to see the outcome of your techniques. When calculating the minutes of manual therapy, it would be 24 minutes as that assessment time is part of the manual therapy time. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Subject: RE: Billing question To: PTManager Date: Thursday, June 2, 2011, 10:29 PM Â Hi, Merle - Thanks for raising a pertinent issue! One very important issue is that one must only bill for the precise CPT Code which they actually perform. If the therapist performs Range of Motion Measurements and records their findings, then they may bill for range of motion measurement. If they also perform manual muscle testing, then they may bill for manual muscle testing. If they did not perform Manual Therapy techniques, they may not bill for manual therapy. When performing manual therapy techniques, one is constantly re-assessing and proceding as indicated, but this does not add billable CPT Codes to the visit. CPT 97002, Re-Evaluation is a separate process -- and a separate document. It is generally used when there has been a significant change in a patient's condition, such as when a hip fracture patient who had become able to walk 400 ft on a two wheeled walker on the sidewalk subsequently experiences seizures, the force of which re-opens a former PEG tube site, and has been on bed rest for a week. (This happened last month!) Re-eval is not a billing code to use casually, or just to write up a progress note to the physician for the patient's follow-up visit. It's a real evaluation of an existing, rather than new, patient. Organizations should check their charts intermittently and re-train its staff to: 1) Do the indicated procedure, 2) Document what they have done, and 3) Bill for exactly what they have done that they have documented. I once knew a DPM inTexas who combined the billing for two procedures which he *did* perform into a charge for one " sort of close " procedure which he *did not* actually perform. The insurance company took action against his license for fraud, and he was banned from Medicare program for five years. It's better to coach your staff (and owners, if necessary) to just do the right thing. Lawyers are far too costly! Hope that's useful! Dr. Dick Hillyer, PT Dr. Hillyer, PT,DPT,MBA,MSM Hillyer Consulting 700 El Dorado Pkwy W. Cape Coral, FL 33914 Mobile _____ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, June 02, 2011 3:45 PM To: PTManager Subject: Billing question Hello group, We had a patient call in to complain about her bill today. She stated that on two visits, she was billed manual therapy, 1 unit and never had any manual therapy during those visits. I checked back in the documentation (this is a non-Medicare patient, but our hospital requires us to bill all payers the same). On the first visit, the only thing documented in the chart were measurements of range of motion and manual muscle testing. Under subjective, the patient reported 95% pain relief and the therapist wrote in the assessment/plan " patient doing well, hold chart for 2 weeks- if no further complaints, d/c " ). The next and last visit was 2 weeks later. The patient had an exacerbation. There was more objective testing documented and some ther ex reviewed and modified. Here is what the therapist documented as far as billing: for Visit 1, she billed Manual Therapy, 15 minutes. For visit two, she billed Manual Therapy 20 minutes. My take is that since she can't bill re-eval for Visit 1, she was correct in her billing for that visit. However, she didn't bill for what she documented on Visit 2- her total time was 20 minutes (1 unit), but she didn't break it down by each procedure- it is unclear from her documentation as to which unit she spent more time. So question to the group- do you agree with how she billed? Any suggestions on a simple way to explain our very complicated billing system to a patient who has no clue? Thanks Meryl W. Freeman, MS PT Manager, Rex Hospital Outpatient Rehab (office) ----- Confidentiality Notice ----- This e-mail and any attached documents contain confidential information belonging to the sending entity, Rex Healthcare, and is intended only for the use of the individual(s) or entity(s) associated with the recipient addresses listed in the message header. The authorized recipient of this information is prohibited from disclosing this information to any other party. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of the email and/or attachments is strictly prohibited. If you received this e-mail transmission in error, please notify the sender immediately to arrange for return or destruction of this information. To report abuse or inappropriate use, please email abuse@... <mailto:abuse%40rexhealth.com> .( Quote Link to comment Share on other sites More sharing options...
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