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"Physical Medicine|Physical Therapy" Articles
Click on the title to see the article summary and a link to the full article.
January 11th, 2021
Good and Bad News Regarding the 2021 Medicare Physician Fee Schedule
By Wyn Staheli, Director of Research | Published January 11th, 2021
When the proposed Medicare Physician Fee Schedule came out last year, it really got everyone worried. In a time where we are all facing issues related to COVID, this seemed like a really big problem. Professional organizations lobbied and everyone tried to stop the proposed changes, and the 10.2% decrease didn’t happen, but other changes will still be taking place. So how bad is it really and how will it affect your organization?
October 7th, 2020
Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program
By Wyn Staheli, Director of Research | Published October 7th, 2020
To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.
July 15th, 2020
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 15th, 2020
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
When reporting 93668 for peripheral arterial disease rehabilitation the following ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
April 16th, 2020
Hypertension ICD-10-CM Coding Table, Guidelines, and Tips
By Wyn Staheli, Director of Research & Aimee Wilcox, Director of Content | Published April 16th, 2020
Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.
April 8th, 2020
ICD-10-CM Official Coding and Reporting Guidelines Updated for COVID-19
By Wyn Staheli, Director of Research | Published April 8th, 2020
The ICD-10-CM Official Coding and Reporting Guidelines have just been updated to include COVID reporting. Additional information beyond the previously released interim guidelines are included. These are the rules that should be followed for claims submission. The notice states that this is for April 1, 2020 through September 30, 2020.
March 31st, 2020
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2020
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
March 26th, 2020
New Biofeedback Codes to replace 90911 Eff 2020-01-01
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 26th, 2020
CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911.
According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate.
Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...
October 1st, 2019
Federal Workers Compensation Information
By Wyn Staheli, Director of Research | Published October 1st, 2019
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program.
Division of Federal Employees' Compensation (DFEC) website
Division of Federal Employees' Compensation (DFEC) provider ...
September 30th, 2019
New Codes for Dry Needling
By Wyn Staheli, Director of Research | Published September 30th, 2019
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.
September 3rd, 2019
List of Cranial Nerves
By Find-A-Code | Published September 3rd, 2019
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
August 16th, 2019
Medical ID Theft
By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019
Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
August 9th, 2019
The OIG Work Plan: What Is It and Why Should I Care?
By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
July 17th, 2019
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
By Wyn Staheli, Director of Research | Published July 17th, 2019
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
July 15th, 2019
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
By Wyn Staheli, Director of Research | Published July 15th, 2019
Question:
It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
July 12th, 2019
5 Ways to Minimize HIPAA Liabilities
By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ...
July 8th, 2019
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
By Wyn Staheli, Director of Research | Published July 8th, 2019
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:
Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
May 27th, 2019
Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?
By Wyn Staheli, Director of Research | Published May 27th, 2019 - Last Review/Update June 6th, 2019
Question
Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3.
Also, it shows the ...
May 21st, 2019
RT and LT Modifier Usage Change (effective 2019-03-01)
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 21st, 2019
According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...
May 13th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices
By Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.
March 7th, 2019
Podiatrist Billing for Physical Therapy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2019
It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ...
February 7th, 2019
Q/A: Do Digital X-rays Have Their Own Codes?
By Wyn Staheli, Director of Research | Published February 7th, 2019 - Last Review/Update February 8th, 2019
Question
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
Answer
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
February 5th, 2019
Clinical Staff vs. Healthcare Professional
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
February 1st, 2019
Physical Therapy Caps Q/A
By Wyn Staheli, Director of Research | Published February 1st, 2019 - Last Review/Update February 4th, 2019
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
January 22nd, 2019
CPT Modifiers 96 & 97 for Habilitative and Rehabilitative Services (2018-01-01)
By Find-A-Code | Published January 22nd, 2019
Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. There have been questions on whether modifier 96 will be preferred over HCPCS modifier SZ, which describes the same types of habilitative (but not rehabilitative) services, but payers have not yet indicated which modifier ...
November 29th, 2018
Billing Exercise Equipment
By Wyn Staheli, Director of Research | Published November 29th, 2018
While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...
November 8th, 2018
Muscle Testing and Range of Motion Information
By Wyn Staheli, Director of Research | Published November 8th, 2018
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
October 17th, 2018
Wolters Kluwer Drug Pricing
By Find-A-Code | Published October 17th, 2018
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
October 16th, 2018
Pelvic Floor Dysfunction Treatment Coverage
By Wyn Staheli, Director of Research | Published October 16th, 2018
Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings.
Coverage by payers ...
October 16th, 2018
Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?
By Wyn Staheli, Director of Research | Published October 16th, 2018
Question:
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...
August 16th, 2018
Q/A: Can I Bill Mechanical Massage?
By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
July 25th, 2018
Q/A: Can I Bill Spinal Decompression Table to Insurance?
By Wyn Staheli, Director of Research | Published July 25th, 2018 - Last Review/Update January 28th, 2019
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
June 20th, 2018
Q/A: Should I Bill Massage as 97124 or 97140?
By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019
Question
The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...
June 18th, 2018
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
By Wyn Staheli, Director of Research | Published June 18th, 2018 - Last Review/Update January 30th, 2019
Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.
May 30th, 2018
Coding for Strains in ICD 10
By BC Advantage | Published May 30th, 2018 - Last Review/Update June 4th, 2018
According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....
March 13th, 2018
When is 97112 Neuromuscular Re-education Billable?
By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.
March 8th, 2018
Documentation for Home Health Services (Part A non DRG)
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medical Learning Network provides coverage guidance, which should be documented, for home health services.
March 8th, 2018
Documentation and Orders for Respiratory Assistive Device
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for a respiratory assistive device and ordering guidelines.
March 8th, 2018
Documentation for Inpatient Rehabilitation Facilities
By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 27th, 2018
The Medicare Learning Network provides guidance on required documentation for Inpatient Rehabilitation Facilities (IRF).
March 5th, 2018
Increased Therapy Denials Create Administrative Burden
By Wyn Staheli, Director of Research | Published March 5th, 2018
Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...
February 27th, 2018
CPT Modifers 96 & 97 for Habilitative and Rehabilitative Services
By Jared Staheli | Published February 27th, 2018
Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. CMS has added modifiers 96 and 97 to their edits (see MLN Matters MM10385 here) and modifier SZ is deleted as of December 31, 2017. Private payers should simply adjust their policies to use ...
February 1st, 2018
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
By Find-A-Code | Published February 1st, 2018
According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...
January 31st, 2018
Q/A: Can I Perform 2 Untimed Codes at the Same Time?
By Wyn Staheli, Director of Research | Published January 31st, 2018 - Last Review/Update February 4th, 2019
Question: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?
January 29th, 2018
Insufficient Documentation Errors
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018
According to CMS ICN 909160, claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed, meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims ...
January 15th, 2018
Medicare Requiring Specific Modifiers on Therapy Services
By Wyn Staheli, Director of Research | Published January 15th, 2018
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ...
January 15th, 2018
Billing with a GP Modifier
By Wyn Staheli, Director of Research | Published January 15th, 2018 - Last Review/Update January 30th, 2019
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
January 9th, 2018
Should ROM Testing be Reported with Evaluation and Management Services?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018
Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.
January 9th, 2018
Outpatient Rehabilitation Modifiers
By Jared Staheli | Published January 9th, 2018
Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries.
For services delivered under an outpatient plan of care use modifier:
GN for speech-language pathology
GO for occupational therapy
GP for physical therapy
In addition to using the correct modifier, ...
January 4th, 2018
Beware of Limitations When Using Electrical Stimulation - Ultrasound
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 4th, 2018
Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ...
January 4th, 2018
Reimbursement for Therapy Students
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ...
January 4th, 2018
Proper Usage of Electrical Stimulation
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment.
97032 is a constant attendance electrical stimulation modality ...
January 4th, 2018
Skilled Therapy, When it's Appropriate and Billable
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators,
"A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...
January 4th, 2018
Initial Evaluation Codes for PT's and OT's
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation.
These evaluation codes are untimed, billable as one unit.
Do ...
January 4th, 2018
PT and OT Reevaluation Coding
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...
January 4th, 2018
General Physical Therapy Modality Guidelines
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention.
CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...
January 4th, 2018
Diathermy eg Microwave Use and Documentation
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...
January 4th, 2018
Ultrasound Therapy
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to
3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...
January 4th, 2018
Hydrotherapy Guidelines
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...
January 4th, 2018
Physical Therapist can now bill for a substitute Physical Therapist
By Find-A-Code | Published January 4th, 2018
As of 6/13/2017 Medicare contractors shall accept claims from Physical Therapists, Provider Specialty 65 – Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier.
The A/B MAC Part B may pay the patient’s regular physician for physicians' ...
January 4th, 2018
Billing Negative Pressure Wound Therapy (NPWT) (disposable device)
By Find-A-Code | Published January 4th, 2018
Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes:
97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...
January 4th, 2018
Mechanical Traction Therapy
By Find-A-Code | Published January 4th, 2018
According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...
December 12th, 2017
Documenting the Location and Correct Coding
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017
The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ...
October 31st, 2017
Correct Coding for Group Therapy
By David Klein CPC, CPMA, CHC | Published October 31st, 2017 - Last Review/Update February 5th, 2019
Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically regarding the appropriate use of one-on-one codes as opposed to group therapy code CPT 97150 - Therapeutic procedure(s), group (2 or more individuals). This advisory provides guidance on how to properly use one-on-one and group therapy codes, both independently and together.
October 27th, 2017
Speech-Language Pathology Services Policy from UniCare
By Find-A-Code | Published October 27th, 2017
Medically Necessary:
Rehabilitative speech-language pathology (SLP) services are considered medically necessary when ALL of the following criteria are met:
The services are used in the treatment of communication impairment or swallowing disorders resulting from illness*, injury, surgery, or congenital abnormality; and
Based on a plan of care, the therapy sessions achieve a specific ...
October 20th, 2017
What is the Best Code to use for PNF Stretching of the Hamstrings and Glutes?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 20th, 2017 - Last Review/Update February 8th, 2019
What is the best code to use for PNF stretching of the hamstrings and gluts? The doctor is currently using 97112.
September 1st, 2017
2017 Physical Therapy Evaluation & Management Codes
By Kathy Price, RHIT, CPC, CCS-P, CPMA | Published September 1st, 2017 - Last Review/Update January 31st, 2018
As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy....
August 24th, 2017
Can They Deny Electrical Stimulation by Saying There is no Evidence that it Works?
By Dr Ronald J. Farabaugh | Published August 24th, 2017 - Last Review/Update February 5th, 2019
Topic: Electrical Stimulation (EMS)
Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation
(EMS) by stating that "according ODG electrical stimulation is experimental therefore not
medically necessary or eligible for reimbursement." Is that true?
August 17th, 2017
Quick Tip from the HelpDesk -- Code 97140
By ChiroCode | Published August 17th, 2017 - Last Review/Update January 31st, 2019
Watch this short video, "Secrets of 97140 Manual Therapy," to learn all that you need to know about the proper support for 97140.
ChiroCode_DeskBook_Tips_97140 from Innoventrum on Vimeo.
...
August 8th, 2017
Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019
My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a group of patients? If so, how do I document and bill for this?
August 4th, 2017
Increased Medicare payment rates for FY 2018!
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 4th, 2017
We can look forward to a few prospective payments for Skilled Nursing Facilities, Hospice and Inpatient Rehab; CMS released their final rule and reported on key highlights of the new FY 2018 Medicare payment rules.
CMS States, “The 2018 Skilled Nursing Facility (SNF) Prospective Payment System Final Rule increases Medicare payment rates ...
June 14th, 2017
Ultraviolet Therapy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 14th, 2017 - Last Review/Update July 27th, 2017
Treatment of this type is generally used for patients requiring the application of a drying heat. For example, this treatment would be considered reasonable and necessary for the treatment of severe psoriasis where there is limited range of motion.
Only 1 unit of CPT code 97028 is covered per date of service.
Supportive Documentation ...
June 13th, 2017
Documentation for Physical Therapist
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 13th, 2017 - Last Review/Update July 26th, 2017
Medical review decisions are based on the information submitted in the medical record. Therefore, it is critical that the medical record information submitted is accurate and complete to allow medical review to make a fair payment decision. The medical record information submitted should:
Paint a picture of the patient’s impairments and ...
May 4th, 2017
Therapy Caps, Limits and Providers
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 4th, 2017 - Last Review/Update July 26th, 2017
The annual combined therapy cap is per beneficiary each calendar year. For 2017, this includes Medicare Part B outpatient therapy cap for Occupational Therapy (OT) $1,980, Physical Therapy (PT) and Speech-Language Pathology Services (SLP) $1,980.
In addition there is an exception process, if the therapy services are higher than the limited amounts, the beneficiary ...
April 26th, 2017
Reporting Severity/Complexity for Functional Limitation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 26th, 2017 - Last Review/Update July 28th, 2017
For each nonpayable functional G-code, one of the modifiers listed below must be used to report the severity/complexity for that functional limitation. The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the clinician furnishing the therapy services.
Functional Limitation Severity Modifier Codes
CH 0 percent impaired, limited or ...
April 20th, 2017
Therapy Plan of Care
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 20th, 2017 - Last Review/Update July 28th, 2017
The Local Coverage Determination (LCD) for Outpatient Physical and Occupational Therapy Services describes the coverage limits of outpatient physical and occupational therapy services under Medicare Part B. It's billed to either the Medicare Fiscal Intermediary (FI) or Part A or Medicare Carrier or Part B MAC when services are provided ...
March 24th, 2017
Are There any Alternatives for Code 97112 Neuromuscular Re-education?
By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019
Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits.
March 1st, 2017
High Compression Bandage System Clarification
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 1st, 2017 - Last Review/Update July 28th, 2017
Multi-layered, sustained, graduated, high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. A number of graduated, high-compression bandage systems products have been developed, including Profore®, Dyna-Flex®, Surepress®, Setopress®, and other similar product systems.Providers should note that the treatment of lymphedema with the application ...
February 15th, 2017
Insufficient Documentation
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 15th, 2017 - Last Review/Update August 2nd, 2017
Claims are determined to have insufficient documentation errors when the medical documentation submitted is inadequate to support payment for the services billed - meaning the reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, and/or were medically necessary.
Claims are also ...
February 10th, 2017
Beware of Limitations When Using Electrical Stimulation - Ultrasound
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 10th, 2017 - Last Review/Update August 2nd, 2017
Ultrasound is often used to reduce inflammation and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the ...
January 13th, 2017
Whiplash Damages
By ChiroCode | Published January 13th, 2017 - Last Review/Update January 31st, 2019
Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it.
December 16th, 2016
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
By Find-A-Code | Published December 16th, 2016
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...
August 16th, 2016
Functional Limitation Reporting Codes and Modifiers
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 16th, 2016
The following G-codes are used for reporting on claims for Medicare Part B and must be used with a severity/complexity modifier, the use of G-codes are enforced and required beginning Jan. 01, 2013, claims will be returned or rejected if they do not contain the required functional G-Code/modifier information.
There are ...
August 10th, 2016
Guidance for the Use of Codes in Physical Medicine - Pub-100
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2016 - Last Review/Update August 4th, 2017
The following provides guidance about the use of codes 96105, 97026, 97150, 97545, 97546, and G0128.
• CPT Codes 96105, 97545, and 97546.
Providers report code 96105, assessment of aphasia with interpretation and report in 1-hour units. This code represents formal evaluation of aphasia with an instrument such as the Boston Diagnostic Aphasia Examination. If this formal assessment is performed during treatment, ...
March 29th, 2016
PQRS Measures by Specialty (2016)
By InstaCode Institute | Published March 29th, 2016
Download CMS's Preferred PQRS Measures Lists by Specialty. 17 Specialties to choose from. Find out exactly what CMS is expecting to see reported for your specialty.
February 1st, 2016
Documentation and Billing Practices
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 1st, 2016 - Last Review/Update August 7th, 2017
Prescribed to:
Reduce pain by restricting mobility of the trunk: OR
Facilitate healing following an injury to the spine or related tissue; OR
Otherwise support weak and/or deformed spinal muscles.
Documentation and billing practices be sure you are meeting all the requirements to bill a spinal orthoses.
Spinal Orthoses billed with HPCPCS L0450, L0454, L0621, L0625 and L0628 must be billed with ...
January 29th, 2016
Wound Care & Debridement- Provided by Physician, NPP or as Incident-to Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016
Providers must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required ...
October 20th, 2015
Finding Strain and Sprains in ICD-10-CM
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 20th, 2015
There has been some confusion on Sprain vs. Strain and how to find them in ICD-10-CM. They are now split in two separate code ranges and Injury is now related to the anatomic location specific to the injury.
It will help to remember the following information when searching for Strains vs. ...
August 19th, 2015
G-Codes for Functional Reporting and Severity/Complexity Modifiers
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 19th, 2015
Beginning January 1, 2013, Functional Reporting requires therapy practitioners and providers to report non-payable G-codes and modifiers to convey information about the beneficiary’s functional status including projected goal status throughout the episode of care.
For the severity modifiers, providers should include a description of how the modifiers were determined.
Functional ...
August 10th, 2015
Documentation Requirements for Therapy Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015
Documentation Requirements for Therapy Services, indicates that the amount of time for each specific intervention/modality provided to the patient is not required to be documented in the Treatment Note. However, the total number of timed minutes must be documented. These examples indicate how to count the appropriate number of units ...
August 10th, 2015
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2015 - Last Review/Update August 7th, 2017
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech - language pathology services. They should never be used with codes that are not on the list of applicable therapy services. For example, respiratory therapy services, or nutrition therapy ...
January 8th, 2015
GP Modifier Rule
By | Published January 8th, 2015 - Last Review/Update March 9th, 2016
The GP modifier rule is defined on page 36 of this link: http://www.cms.gov/Regulations-and-guidance/Guidance/Manuals/downloads/clm104c05.pdfIn short, providers are supposed to append the GP modifier to any physical therapy type services when submitting them to Medicare. The result will be the same...the service will deny because therapies are not covered by Medicare. Medicare ...
December 18th, 2014
Outpatient Therapy Functional Reporting Requirements
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 18th, 2014 - Last Review/Update March 1st, 2016
Functional Reporting, using the G-codes and as described below:
• At the outset of a therapy episode of care, i.e., on the DOS for the initial therapy service;
• At every progress reporting period, which occurs at least once every 10 treatment days;
• At the DOS that an evaluative or re-evaluative procedure ...
October 22nd, 2014
Q & A: 97022 and Dry Hydromassage
By | Published October 22nd, 2014 - Last Review/Update January 27th, 2017
Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do ...
October 17th, 2014
Physical Therapy - Applicable Revenue Codes Rev 09-03-10
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 17th, 2014 - Last Review/Update January 30th, 2017
The appropriate revenue codes for reporting outpatient rehabilitation services are:
0420 - Physical Therapy Services
0430 - Occupational Therapy Services
0440 - Speech-language pathology services
Medicare contractors edit to assure the presence of a HCPCS code when revenue codes 0420, 0430, 0440, or 0470 are reported
Medicare Claims Processing Manual Chapter 5 -Part B Outpatient ...
October 9th, 2014
Medicare Caps on Therapy Services
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 23rd, 2017
Medicare has set annual therapy caps at $1920 and they start over Jan. 1 of each year. Medicare combined the therapy limits SLP (Speech-Language Pathology) and PT (Physical Therapy) for a combined total of $1920.00 in 2014. There is also a therapy cap limit for OT (Occupational Therapy) Services of $1920. ...
October 9th, 2014
Physical Therapy Part B Outpatient Rehabilitation and CORF / OPT Services Ch 5 - CMS claims processing manual Rev08-15-2014
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 30th, 2017
For detailed information on CMS Claims processing for Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation Facility (CORF) Services -General
Visit : CMS.gov
...
October 9th, 2014
Physical Therapy - Type of Serivce Codes
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 30th, 2017
U = Occupational therapy
W= Physical therapy
Medicare Claims Processing Manual Chapter 5 -Part B Outpatient Rehabilitation and CORF/OPT Services
...
October 9th, 2014
Out Patient Rebab - CORF 75X Bill Types
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 9th, 2014 - Last Review/Update January 30th, 2017
Effective October 1, 2012, the following revenue codes are allowable for reporting CORF services on 75X bill types:
0270
0274
0279
029X
0412
0419
042X
0410
044X
0550
0559
043X
0636
0771
0911
0569
0942
NOTE: Billed revenue codes not listed in the above list will be returned to the provider by Medicare systems. See Chapter 25, Completing and Processing the CMS-1450 Data Set, for revenue code descriptions
...
August 7th, 2014
NGS - Therapy Functional Reporting Claims Rejecting in Error
By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017
NGS (National Government Services) has announced a Production Alert: Therapy functional reporting claims may be rejecting incorrectly. These are claims referred to in the MLN Article # SE1307, Outpatient Therapy Functional Reporting Requirements. You can read more about about which claims are a part of the OP therapy functional reporting ...
February 13th, 2014
Muscle Testing Table
By | Published February 13th, 2014 - Last Review/Update August 3rd, 2018
Muscle and Range of Motion Testing guidelines have recently been clarified in the AMA CPT Assistant. Muslce Testing Table included
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