Guest guest Posted August 11, 2011 Report Share Posted August 11, 2011 , The AMA clearly defines the physical medicine billable services in the CPT manual. It doesn't matter if the payer is Medicare or managed care. The definitions for group therapy (or any other service) applies to all payers. The APTA provides some helpful group therapy billing scenarios on their website. One option mentioned is to split the total time between two patients who are being treated by one PT and bill one-to-one for each patient. Jon Mark Pleasant, PT > > Dear Group, > > Today has been the day for challenging client questions. Thanks to all > for responding to the PT student treating Medicare patients. > > A different client has challenged me to " prove " that the group therapy code > 97150 applies to all insurance carriers not just Medicare. My > understanding is that if you are not providing one-on-one therapeutic exercise to an > individual, but instead are providing " group therapy " to two or more > patients at the same session you must bill 97150, regardless if the patient has > commercial insurance or Medicare. > > The client is billing the Medicare patient for 97150 and billing the > commercial patient 97110. Who is right in this debate? Please provide a > written ruling on this question if possible. > > Have a great evening, > Vickie > > > > D. Cavitt, President > > > Rehab Billing Specialists, L.L.C. > 600 Guilbeau Road, Suite A > Lafayette, LA 70506 > Phone > Fax > _www.rehabilling.com_ (http://www.rehabilling.com/) > > > > > This transmission may contain information that is privileged, > confidential, and/or exempt from disclosure under applicable law. If you are not the > intended recipient, you are hereby notified that any disclosure, copying, > distribution, or use of the information contained herein (including any > reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in > error, please immediately contact the sender and destroy the material in its > entirety, whether in electronic or hard copy format. Thank you. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2011 Report Share Posted August 11, 2011 The CPT code definition clearly defines that 2 or more clients seen at the same time by the same provider will be billed using 97150. Using a timed code for individual care in a group therapy setting , in my opinion, is fraudulent. There is no difference when used to bill commercial providers . Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services Ephraim McDowell Health PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. Group Therapy Dear Group, Today has been the day for challenging client questions. Thanks to all for responding to the PT student treating Medicare patients. A different client has challenged me to " prove " that the group therapy code 97150 applies to all insurance carriers not just Medicare. My understanding is that if you are not providing one-on-one therapeutic exercise to an individual, but instead are providing " group therapy " to two or more patients at the same session you must bill 97150, regardless if the patient has commercial insurance or Medicare. The client is billing the Medicare patient for 97150 and billing the commercial patient 97110. Who is right in this debate? Please provide a written ruling on this question if possible. Have a great evening, Vickie D. Cavitt, President Rehab Billing Specialists, L.L.C. 600 Guilbeau Road, Suite A Lafayette, LA 70506 Phone Fax _www.rehabilling.com_ (http://www.rehabilling.com/) This transmission may contain information that is privileged, confidential, and/or exempt from disclosure under applicable law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately contact the sender and destroy the material in its entirety, whether in electronic or hard copy format. Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 Jeff: We no longer do group aquatic therapy as " Medicare does not feel it is therapeutically effective and did not constitute skilled therapy required of a PT " . They did not want pay for that, even though we showed progress. We now will only do one-on-one in the water for a few sessions prior to sending them back to land based therapy. One of the auditors actually told me that " patients don't have gills and shouldn't need that much aquatic. Get them to land as quickly as you can " . While I tried to fight the fight, I eventually gave up the group therapy and now concentrate on one-on-one. Subject: group therapy To: PTManager Date: Friday, April 6, 2012, 9:51 AM  Question for the group with regard to charging/billing for group therapy (CPT 97150). Am I correct in that the use of this code (whether for aquatic or gym patients) can only be used when all participants are receiving the exact same exercises at the same time and NOT for when you have 2-5 patients doing their individual programs but at the same time under the supervision of one clinician? It has always been my understanding that individual exercise programs done in a group setting can only be billed as therapeutic exercise (97110) or aquatic therapy (97113) and only for the actual one on one minutes spent with the therapist. Thanks, Jeff Brown PT Director of Rehabilitation Decatur Memorial Hospital 2300 N. St. Decatur, IL 62526 CONFIDENTIAL: This email message and any attachments are for the sole use of the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL HEALTH INFORMATION. It is to be used only to aid in providing specific healthcare services to this patient. Any unauthorized review,use, disclosure, or distribution is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, please contact the sender by reply email and destroy all copies of the original message immediately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 Jeff: We no longer do group aquatic therapy as " Medicare does not feel it is therapeutically effective and did not constitute skilled therapy required of a PT " . They did not want pay for that, even though we showed progress. We now will only do one-on-one in the water for a few sessions prior to sending them back to land based therapy. One of the auditors actually told me that " patients don't have gills and shouldn't need that much aquatic. Get them to land as quickly as you can " . While I tried to fight the fight, I eventually gave up the group therapy and now concentrate on one-on-one. Subject: group therapy To: PTManager Date: Friday, April 6, 2012, 9:51 AM  Question for the group with regard to charging/billing for group therapy (CPT 97150). Am I correct in that the use of this code (whether for aquatic or gym patients) can only be used when all participants are receiving the exact same exercises at the same time and NOT for when you have 2-5 patients doing their individual programs but at the same time under the supervision of one clinician? It has always been my understanding that individual exercise programs done in a group setting can only be billed as therapeutic exercise (97110) or aquatic therapy (97113) and only for the actual one on one minutes spent with the therapist. Thanks, Jeff Brown PT Director of Rehabilitation Decatur Memorial Hospital 2300 N. St. Decatur, IL 62526 CONFIDENTIAL: This email message and any attachments are for the sole use of the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL HEALTH INFORMATION. It is to be used only to aid in providing specific healthcare services to this patient. Any unauthorized review,use, disclosure, or distribution is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, please contact the sender by reply email and destroy all copies of the original message immediately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 Jeff: We no longer do group aquatic therapy as " Medicare does not feel it is therapeutically effective and did not constitute skilled therapy required of a PT " . They did not want pay for that, even though we showed progress. We now will only do one-on-one in the water for a few sessions prior to sending them back to land based therapy. One of the auditors actually told me that " patients don't have gills and shouldn't need that much aquatic. Get them to land as quickly as you can " . While I tried to fight the fight, I eventually gave up the group therapy and now concentrate on one-on-one. Subject: group therapy To: PTManager Date: Friday, April 6, 2012, 9:51 AM  Question for the group with regard to charging/billing for group therapy (CPT 97150). Am I correct in that the use of this code (whether for aquatic or gym patients) can only be used when all participants are receiving the exact same exercises at the same time and NOT for when you have 2-5 patients doing their individual programs but at the same time under the supervision of one clinician? It has always been my understanding that individual exercise programs done in a group setting can only be billed as therapeutic exercise (97110) or aquatic therapy (97113) and only for the actual one on one minutes spent with the therapist. Thanks, Jeff Brown PT Director of Rehabilitation Decatur Memorial Hospital 2300 N. St. Decatur, IL 62526 CONFIDENTIAL: This email message and any attachments are for the sole use of the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL HEALTH INFORMATION. It is to be used only to aid in providing specific healthcare services to this patient. Any unauthorized review,use, disclosure, or distribution is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, please contact the sender by reply email and destroy all copies of the original message immediately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 Jeff Group charge use was clarified sometime ago by CMS as skilled therapy provided to two or more individuals simultanteously by a practitioner. " The individuals can be, but need not be, performing the same activity. The therapists involved in group therapy services must be in constant attendance and must provide skilled services to the group " . (Transmital 1753; Medicare Benefits Policy Manual, Chapter 15, section 230). If you are treating two or more patients simulataneously (including shuttling between the two) it is Group Therapy and each patient would receive a charge of 97150. Alternatively, you could split your total time spent in the group and bill for 1:1 timed charges to each patient but only for the minutes spent in 1:1 contact with the patient AND the total number of timed units cannot exceed the total time you spent in the group. So if you had 4 patients for a 60 minute overlap /group, you either bill each patient a group charge ( untimed ) OR each patient 1 unit of some skilled service ( 97110, 97140 etc) that you were providing when you were with them 1:1, for a total of 4 units or 60 min of your time. It would be inappropriate to bill each patient 4 units of 1:1 time for that group/overlapping time, even if they were doing different things because you are not spending 1:1 time with them each for the entire hour. There are several sample billing scenarios in the Medicare Manual that help clairfy these type of situations. We schedule 1:1 whenever possible and try to avoid the whole issue of group...Patients are happy, they rarely cancel, outcomes are good, and it works financially. And it keeps us out of orange jumpsuits... Marcy Stalvey, PT, NCS Therapy Supervisor Edwin Shaw Rehabilitation Institute Cuyahoga Falls, OH 44221 From: PTManager [mailto:PTManager ] On Behalf Of JEFF BROWN Sent: Friday, April 06, 2012 9:52 AM To: PTManager Subject: group therapy Question for the group with regard to charging/billing for group therapy (CPT 97150). Am I correct in that the use of this code (whether for aquatic or gym patients) can only be used when all participants are receiving the exact same exercises at the same time and NOT for when you have 2-5 patients doing their individual programs but at the same time under the supervision of one clinician? It has always been my understanding that individual exercise programs done in a group setting can only be billed as therapeutic exercise (97110) or aquatic therapy (97113) and only for the actual one on one minutes spent with the therapist. Thanks, Jeff Brown PT Director of Rehabilitation Decatur Memorial Hospital 2300 N. St. Decatur, IL 62526 CONFIDENTIAL: This email message and any attachments are for the sole use of the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL HEALTH INFORMATION. It is to be used only to aid in providing specific healthcare services to this patient. Any unauthorized review,use, disclosure, or distribution is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, please contact the sender by reply email and destroy all copies of the original message immediately. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 Jeff Group charge use was clarified sometime ago by CMS as skilled therapy provided to two or more individuals simultanteously by a practitioner. " The individuals can be, but need not be, performing the same activity. The therapists involved in group therapy services must be in constant attendance and must provide skilled services to the group " . (Transmital 1753; Medicare Benefits Policy Manual, Chapter 15, section 230). If you are treating two or more patients simulataneously (including shuttling between the two) it is Group Therapy and each patient would receive a charge of 97150. Alternatively, you could split your total time spent in the group and bill for 1:1 timed charges to each patient but only for the minutes spent in 1:1 contact with the patient AND the total number of timed units cannot exceed the total time you spent in the group. So if you had 4 patients for a 60 minute overlap /group, you either bill each patient a group charge ( untimed ) OR each patient 1 unit of some skilled service ( 97110, 97140 etc) that you were providing when you were with them 1:1, for a total of 4 units or 60 min of your time. It would be inappropriate to bill each patient 4 units of 1:1 time for that group/overlapping time, even if they were doing different things because you are not spending 1:1 time with them each for the entire hour. There are several sample billing scenarios in the Medicare Manual that help clairfy these type of situations. We schedule 1:1 whenever possible and try to avoid the whole issue of group...Patients are happy, they rarely cancel, outcomes are good, and it works financially. And it keeps us out of orange jumpsuits... Marcy Stalvey, PT, NCS Therapy Supervisor Edwin Shaw Rehabilitation Institute Cuyahoga Falls, OH 44221 From: PTManager [mailto:PTManager ] On Behalf Of JEFF BROWN Sent: Friday, April 06, 2012 9:52 AM To: PTManager Subject: group therapy Question for the group with regard to charging/billing for group therapy (CPT 97150). Am I correct in that the use of this code (whether for aquatic or gym patients) can only be used when all participants are receiving the exact same exercises at the same time and NOT for when you have 2-5 patients doing their individual programs but at the same time under the supervision of one clinician? It has always been my understanding that individual exercise programs done in a group setting can only be billed as therapeutic exercise (97110) or aquatic therapy (97113) and only for the actual one on one minutes spent with the therapist. Thanks, Jeff Brown PT Director of Rehabilitation Decatur Memorial Hospital 2300 N. St. Decatur, IL 62526 CONFIDENTIAL: This email message and any attachments are for the sole use of the intended recipient(s) and may contain HIGHLY CONFIDENTIAL PERSONAL HEALTH INFORMATION. It is to be used only to aid in providing specific healthcare services to this patient. Any unauthorized review,use, disclosure, or distribution is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended recipient or a person responsible for delivering this message to an intended recipient, please contact the sender by reply email and destroy all copies of the original message immediately. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.