CPT Codes/Audits

[Guest guest]

Hello,

I am looking for some input from someone who has been through a Medicare audit.

As a clinic, we are trying to keep reimbursement as high as possible while

treating always one on one with our patients. Since insurance reimbursement is

not going up I am starting to evaluate the CPT codes and their potential

reimbursement. It seems Manual Therapy (97140) is one of the lowest reimbursed

codes where as Therapeutic Activities (97530), Neuromuscular Re-Education

(97112) and Therapeutic Exercise (97110) are the highest. We try everything we

can to meet Medicare requirements and guidelines.

My questions are in an audit:

1. How closely are clinical notes and charges looked at?

2. How strict do they hold to CPT code book definitions?

3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any that

fall under greater scrutiny?

So my task is to get the exact definitions of the CPT codes (more than what just

the CPT code book defines) to provide to the therapist for justification in

their billing and find out if an audit that this is something they really " dig "

into.

Thanks for any input anyone might have.

Heidi

Billing Manager

[Guest guest]

With all due respect,

Provision of skilled care is dictated by what the patient needs, not by

the code that brings a higher reimbursement.

TE is TE , TA is TA, and so on.

The therapist is the one to determine and be responsible for the

justification behind the use of the code/charge

The CPT code book provides the definition, and the skilled therapy

provided must support its use, there is no wiggle room

Ron Barbato PT

Administrative Director, Rehabilitation Services

Program Director, Cancer Support Services

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CPT Codes/Audits

Hello,

I am looking for some input from someone who has been through a Medicare

audit. As a clinic, we are trying to keep reimbursement as high as

possible while treating always one on one with our patients. Since

insurance reimbursement is not going up I am starting to evaluate the

CPT codes and their potential reimbursement. It seems Manual Therapy

(97140) is one of the lowest reimbursed codes where as Therapeutic

Activities (97530), Neuromuscular Re-Education (97112) and Therapeutic

Exercise (97110) are the highest. We try everything we can to meet

Medicare requirements and guidelines.

My questions are in an audit:

1. How closely are clinical notes and charges looked at?

2. How strict do they hold to CPT code book definitions?

3. Of the 3 best reimbursed CPT codes 97530, 97112, 97110 are there any

that fall under greater scrutiny?

So my task is to get the exact definitions of the CPT codes (more than

what just the CPT code book defines) to provide to the therapist for

justification in their billing and find out if an audit that this is

something they really " dig " into.

Thanks for any input anyone might have.

Heidi

Billing Manager