Rehabilitation Outcomes Review-Billing and charging competency
(Editor's note: Ingham Regional Medical Center's rehab department has created a competency program for staff on Medicare billing and reimbursement. These guidelines explain some of the definitions and terms to therapists and other staff.)
The Health Care Financing Administration (HCFA) has provided clarification on counting units that has erupted into a professionwide (PT, OT, and SLP) discussion about how to charge for services. The objective of this competency is to instruct staff in the current billing guidelines provided by HCFA. Each staff member will complete a test on patient scenarios to ensure we all interpret the guidelines in the same manner.
1. Debridement. We can now bill for active debridement. Code G1069 will be added to our chargemaster in the near future. G1069 is the HCPCS code for removal of devitalized tissue, without anesthesia. This can be done by using high pressure jets, scissors, or scalpels and/or scrubbing with gauze. This charge does not include application or removal of bandages or topical agents. This is an untimed code and can be billed one time/visit.
2. Whirlpool. We will maintain our whirlpool (WP) charge, but delete our special WP charge. WP should not be used as a single modality but as a precursor to other forms of treatment for the enhancement of that treatment. Examples include:
• to warm tissue as a precursor to exercise;
• to cool tissue to reduce pain and swelling, therefore improving the quality of exercises;
• to clean a contaminated dirty wound, which is not the same as debridement; this is the cleaning of drainage or foreign material that may be contaminating the wound and could cause an infection;
• to remove bandages that have become embedded and stuck in the wound;
• to debride/remove devitalized tissue.
3. Group therapy. CPT code 97150 has been the focus of debate between HCFA and therapists. There is significant controversy on how this code should be used. It is our stance that the group therapy code will be used in this manner:
When the therapist or assistant is responsible for the treatment of more than one patient at a time, the group therapy code will be used for that patient not receiving one-on-one treatment from the therapist. For example, Patient A is exercising on the upper-body ergometer, while Patient B is receiving manual therapy treatment from the therapist. Patient A will receive a group therapy charge during that time the therapist is one-on-one with Patient B. Patient B will receive a manual therapy charge for that one-on-one treatment.
4. Manual therapy. All manual therapy techniques have been lumped together under manual therapy code 97140. This code covers myofascial, muscle energy, mobs, manipulation, manual traction, and manual lymphatic drainage. Continue to specify what technique was used in your notes.
5. Orthotic fitting/training. This code cannot be used in conjunction with gait training unless two separate areas are being treated. This must be clarified in your documentation.
To determine what to bill the patient:
1. Determine the total time the patient was treated.
2. Separate out untimed treatment minutes and timed treatment minutes.
3. Translate the total time treated into the corresponding units.
4. Charge for the services that take the longest time.
| WHAT IS A UNIT? | |
| 1 unit = 8-22 minutes | 5 units = 68-82 minutes |
| 2 units = 23-27 minutes | 6 units = 83-97 minutes |
| 3 units = 38-52 minutes | 7 units = 98-112 minutes |
| 4 units = 53-67 minutes | 8 units = 113-128 minutes |
* Example A: If 24 minutes of neuromuscular re-education and 23 minutes of therapeutic exercise were furnished, then the total treatment time was 47 minutes, so only three units can be billed for the treatment. The correct coding is two units of neuro re-education and one unit of therapeutic exercise, assigning more units to the service that took more time.
* Example B: If a therapist delivers five minutes of US, six minutes of manual techniques, and 10 minutes of therapeutic exercise, then the total minutes are 21, and only one unit can be paid. Bill one unit of 97110 (the service with the longest time), and the clinical record will serve as documentation that the other two services also were performed.
* Examples taken from the Michigan Medicare B Bulletin, April 2000.
Need More Information?
Teresa Vinson, MPA, PT, Rehab Supervisor, Ingham Regional Medical Center Rehab Department, 401 W. Greenlawn Ave., Lansing, MI 48910-0899. Telephone: (517) 377-8412.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content