Guest guest Posted April 6, 2012 Report Share Posted April 6, 2012 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 Group code is to be used whenever a single clinician is managing/supervising more than one patient at the same time, regardless of what these patients are doing. The patients do not have to be involved in the exact same routine. All other CPT codes require the specific 1:1 attention of a single provider. However if the provider is able to move from one patient to the other and keeps track of the time spent with each patient then that provider may bill each patient for the specific treatment provided, obviously you may only bill each patient for the time actually spent with the patient. van Well, PT Henry Ford Health System Detroit, MI Sent from my 'new' iPad > 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 Hi Jeff, First are you talking about an outpatient clinic or in a SNF setting? Are you talking about Medicare or all insurances? Those things will help narrow down the responses. From the APTA page on Group Therapy: " Pay for outpatient physical therapy services (which includes speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services. The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required. " If you are a APTA member, there is a complete and thorough page of information on Group Therapy with scenarios that should answer your questions. The page under the " Payment " section and " Coding and Billing " subsection. I will speak to part of your question: Bottom line for anyone billing Medicare clients in an outpatient setting: if you have more than one Medicare patient in the clinic at one time under your supervision as a PT and you are billing any code designated that you are in attendance or one-on-one with that patient, then you should be billing only the time that you spend with them one-on-one. Past that the group code comes into play. If you have more than one Medicare patient in the clinic at one time under your supervision, you must bill a group therapy code. I have witnessed a clinic that provided free transportation to Medicare patients, bring 6 Medicare clients to an outpatient clinic, have them all being " treated " together under the supervision on one PT and then billing 3 - 4 units of timed codes per patient. It is unbelievable that this still goes on. I am not saying that I agree with all the Medicare regulations but they are very clear and very specific about group therapy. If you are talking about a SNF setting the group therapy regulations are different, so let us know which one. M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of JEFF BROWN Sent: Friday, April 06, 2012 7:52 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 Hi Jeff, First are you talking about an outpatient clinic or in a SNF setting? Are you talking about Medicare or all insurances? Those things will help narrow down the responses. From the APTA page on Group Therapy: " Pay for outpatient physical therapy services (which includes speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services. The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required. " If you are a APTA member, there is a complete and thorough page of information on Group Therapy with scenarios that should answer your questions. The page under the " Payment " section and " Coding and Billing " subsection. I will speak to part of your question: Bottom line for anyone billing Medicare clients in an outpatient setting: if you have more than one Medicare patient in the clinic at one time under your supervision as a PT and you are billing any code designated that you are in attendance or one-on-one with that patient, then you should be billing only the time that you spend with them one-on-one. Past that the group code comes into play. If you have more than one Medicare patient in the clinic at one time under your supervision, you must bill a group therapy code. I have witnessed a clinic that provided free transportation to Medicare patients, bring 6 Medicare clients to an outpatient clinic, have them all being " treated " together under the supervision on one PT and then billing 3 - 4 units of timed codes per patient. It is unbelievable that this still goes on. I am not saying that I agree with all the Medicare regulations but they are very clear and very specific about group therapy. If you are talking about a SNF setting the group therapy regulations are different, so let us know which one. M.Howell, P.T., M.P.T. IPTA Payment Specialist Meridian, Idaho thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of JEFF BROWN Sent: Friday, April 06, 2012 7:52 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...
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