3 days without Therapy

[Guest guest]

Does anyone have concrete info from the regs(and location in regs) regarding:

1. Medicare A:  3 days without ANY therapy, the patient must be discharged and

evaled

2. Using  another payor days into the look back period for MCA: Example;

Private insurance/HMO for 1-3 days of the admit and then converted to MCA on day

4 of stay (day 1 of Medicare). Can you use  days1-3 of the admit in that

Medicare look back to establish the 5 day reimbursement? Where are the regs for

that?

Thanks

Tamera J. Bounds

Regional Rehab Director, RehabPro

817- 683-2445

The purpose of life is to matter, to be productive, to have it make some

difference that you lived at all--Arthur Prince

 

>

> Dear Rick: I always appreciate your help. Thank you.

> Do you have the LCD number for this? I can't find it on the website and in

calling Medicare, I did not get any

> clarification that this LCD exists.

>

> Alliance Physical Therapy,

> Eugene, OR.

>

> NGS Releases New PT and OT LCD Today

>

> National Government Services has released a new PT and OT LCD in effect today,

November 1, 2010. The major change is the requirement that one of the V codes

listed below must be on the claim as the primary diagnosis in addition to a

secondary DX to justify the specific condition for the reason for therapy.

Please see the posted information below. You can access the NGS LCD through my

website at:

>

> http://www.gawendaseminars.com/medicare_carriers.aspx

>

> When coding for therapy services, the primary diagnosis codes should indicate

the reason for the encounter, and the specific condition for which therapy

services are provided MUST also be included as secondary and subsequent

diagnoses. Claims without secondary diagnoses may be denied.

>

> Primary Diagnoses:

>

> V57.1 CARE INVOLVING OTHER PHYSICAL THERAPY

> V57.21 CARE INVOLVING OCCUPATIONAL THERAPY

> V57.3 CARE INVOLVING SPEECH-LANGUAGE THERAPY

> V57.81 CARE INVOLVING ORTHOTIC TRAINING

> V57.89 CARE INVOLVING OTHER SPECIFIED REHABILITATION PROCEDURE

>

> Rick Gawenda, PT

> President/CEO

> Gawenda Seminars & Consulting

> www.gawendaseminars.com

>

>

>