Re: Palmetto Initiates PT Probe Review

[Guest guest]

Well, that would appear to be about the most frequent billed procedures

left for most of us still practicing in PP. What's the issue? Is the

evidence of over billing, frequency, or something else nefarious?

PT

In a message dated 4/13/2012 8:11:33 A.M. Eastern Daylight Time,

rick0905@... writes:

Jurisdiction 11 Part B

Medical Review Probe: Outpatient Physical Therapist in Private Practice

Minor Procedures (Other) Procedure Codes

The J11 A/B MAC Medical Review department will perform a service-specific

prepay probe review on outpatient claims in North Carolina, South Carolina,

Virginia and West Virginia. Data analysis identified 12 ‘physical

therapist in private practice outpatient services’ with significant frequency

in

these states. Further analysis indicated the procedure codes listed below as

most frequently billed codes for ‘physical therapist in private practice

minor procedures (other)’ in North Carolina, South Carolina, Virginia and

West Virginia. Claims review will be performed on approximately 100 claims per

state for each of the procedure codes selected. The procedure codes

identified are:

CPT code 97113 (Therapeutic procedure, one or more areas, each 15 minutes:

aquatic therapy with therapeutic exercises)

CPT code 97110 (Therapeutic procedure, one or more areas, each 15 minutes:

therapeutic exercises to develop strength and endurance, range of motion

and flexibility)

CPT code 97530 (Therapeutic activities, direct -one on one- patient

contact by the provider; use of dynamic activities to improve functional

performance, each 15 minutes)

CPT code 97140 (Manual therapy techniques (e.g.,

mobilization/manipulation, manual lymphatic drainage, manual traction), one or

more regions, each 15

minutes)

CPT code 97112 (Therapeutic procedure, one or more areas, each 15 minutes:

neuromuscular reeducation of movement, balance, coordination, kinesthetic

sense, posture, and /or proprioception for sitting and/or standing

activities)

CPT code 97116 (Therapeutic procedure, one or more areas, each 15 minutes:

gait training (includes stair climbing)

CPT code 97032 (Application of a modality to one or more areas; electrical

stimulation (manual), each 15 minutes)

CPT code 97016 (Application of a modality to one or more areas;

vasopneumatic devices)

CPT code 97150 (Therapeutic procedure(s), group (two or more individuals)

CPT code 97012 (Application of a modality to one or more areas; traction,

mechanical)

CPT code 97535 (Self-care/ home management training (e.g., activities of

daily living (ADL) and compensatory training, meal preparation, safety

procedures, and instructions in use of assistive technology devices/ adaptive

equipment) direct one on one contact by provider)

CPT code 97035 (Application of a modality to one or more areas; ultrasound

each 15 minutes)

Providers who receive an Additional Documentation Request (ADR) must

submit the requested medical record information within 30 days to:

J11 Part B Medical Review

Mail Code: AG-230

P.O. Box 100238

Columbia, SC 29202-3238

Or fax it to (803) 699-2434

Providers should ensure the accuracy of their billing and send the

following documentation when responding to the ADRs:

Patient’s medical record

Plan of care

Chart notes

Diagnostic test results/reports, including imaging reports

Clinical/therapy notes

Therapy progress notes

Please submit all documentation to support the medical necessity of

services/procedure code billed

If you question the legibility of your signature, you may submit a

signature log or an attestation statement in your ADR response. Medicare

requires

that medical record entries for services provided/ordered be authenticated

by the author. The method used shall be a handwritten or an electronic

signature. Stamp signatures are not acceptable. Patient identification, date of

service and provider of the service should be clearly identified on the

submitted documentation.

Completed review results will be posted to the Palmetto GBA Web site.

Individual providers with significant denials will be contacted for one-on-one

education.

Questions regarding this review may be directed to the Medical Review

department at .

Rick Gawenda, PT

President

Gawenda Seminars & Consulting, Inc.

www.gawendaseminars.com

Follow Gawenda Seminars & Consulting, Inc on Facebook

Register for the April 24, 2012 audio conference: " Using Risk Assessment

to Establish and Implement a Monitoring & Auditing Program " at

_https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1872_

(https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1872)

Register for the PQRS webinar on May 23, 2012 at

_https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1885_

(https://www.showmyevent.com/events/viewEventDetails.aspx?EventID=1885)