RE: Direction and clarity

[Guest guest]

Hi, Damon -

Consider that HIPAA (which is a Federal law) states that there will be only

one national code set for descriptors. The Feds have also said that the

single national set of descriptors will be the AMA's Common Procedural

Terminology (CPT) Codes. There is a myth abounding that a PT may bill

differently for Medicare and non-Medicare.

Therefore, there is to be no difference between coding for Medicare and

non-Medicare insurors. When a CPT code says that it refers to services of a

therapist, the least you may do is use an LPTA.

As far as the CPT 97150 " Group " charge, it is to be used for any (Medicare

or not) charge for a therapeutic procedure where the therapist's time is not

dedicated to one single patient.

I hope this helps.

Dick Hillyer, DPT

Dr. Hillyer, PT,DPT,MBA,MSM

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Damon Whitfield

Sent: Tuesday, September 13, 2011 4:06 PM

To: ptmanager

Subject: Direction and clarity

I am struggling to find some answers and direction and am hoping you can

help. We seem to have some debate in using group codes, use of ATCs and

" best " billing practices in a 3 clinic outpatient setting. I have looked

through contracts, asked other therapists and individuals at our state level

(Michigan). All of whom state there are grey areas and cannot point to any

black and white concrete info on some issues we have. I will present a few

scenarios and see where that leads me (us).

1.Do you use the group charge for other patients than MC (one MC pt and

one BC pt at the same time seen from 8:00 till 9:00?) or can you bill

individually for the BC pt and MC pt if you are using an aide to perform

those designated acts tasks and functions that are still kinda blurry to me

with the BC pt?

2.Since there is some ambiguity on the use of ATCs in the clinic (in

Michigan), is there any scenario, or payer mix, that would allow me to bill

PT services provided by an ATC in the clinic? I have seen in black and white

where MC states they will not reimburse for services if provided by anyone

other than a PT or PTA. I looked at the BC contract and the WC MVA info we

have and could not find anything one way or the other for them. Can I

utilize an ATC to see those pts and bill for it?

3. How about a licensed Massage therapist doing massage on a WC or MVA

pt? Anything there?

Any help I can get would be greatly appreciated. There seems to be a vast

array of " interpretation " of these things and no one can show it to me in

writing. I would be happy to look into hiring a consultant to get us all on

the same page to keep us on track so as to not fall victim to the " ..oh I

did not know that " defense to an auditor if anyone has suggestions

Thanks,

Damon PT