When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15-minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.
Full Answer
How to bill for Occupational Therapy Medical Billing?
Total Treatment Time: 55 minutes. A 30 minute OT initial evaluation is completed (97162), followed by 20 minutes fluidotherapy (97022). Time documentation in the treatment note. Timed Code Treatment Minutes: 0 minutes . Total Treatment Time: 50 minutes
How long does it take to bill for an ultrasound?
The key to occupational therapy medical billing is to understand whether it is a time-based CPT code or an untimed CPT code. Finally, if there is no time designated in the official descriptor, the code represents a typical session and should only be reported as one unit.
What is ultrasound in occupational therapy?
See Common Mistakes in Occupational Therapists Make When Billing for more mistakes and how to avoid them. OT Evaluation CPT Codes. Occupational therapy evaluation codes are broken into three tiers based on the level of complexity. Each one has a corresponding CPT code. An occupational therapy reevaluation has a single CPT code.
How many minutes of manual therapy is 97140?
Ultrasound (US) is a common physical agent modality used in Occupational Therapy. It involves an ultrasound unit and transducers. The ultrasound unit and transducer creates sound waves that penetrate tissues of the body, and causes vibrations of the molecules within the tissues receiving the sound waves. Therapist can manipulate frequency, duty cycle, dosage, treatment duration, …
Is ultrasound therapy a timed code?
Timed codes require the furnishing provider (e.g., the therapist) to remain in constant attendance with—and/or provide constant contact to—the patient receiving the service....Common Timed PT Codes.97110Therapeutic Exercise97112Neuromuscular Re-Education97116Gait Training97035Ultrasound97033Iontophoresis3 more rows•May 25, 2021
When reporting time based treatment time the therapist includes what time?
A treatment encounter note is required to include two-time elements: the total time-based treatment minutes and the total treatment minutes. The total treatment minutes includes both time spent providing time based and untimed code services.Jul 28, 2020
What is the 8 minute rule in occupational therapy?
A therapist must provide direct one-to-one therapy for at least 8 minutes to receive reimbursement for a time based treatment code. When only one service is provided in a day, you shouldn't bill for services performed for less than 8 minutes.
Is 97012 a timed or untimed code?
Performing treatment based on an 'untimed' CPT code means that you won't need to record the specific amount of time spent performing the treatment. Regardless of whether you spend 10, 20, or 30 minutes assisting a patient with mechanical traction (CPT 97012), you can only bill 1 unit.
Is manual therapy a timed code?
Or manual therapy for 6 minutes? That's where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes....Minutes and Billing Units.8 – 22 minutes1 unit53 – 67 minutes4 units68 – 82 minutes5 units83 minutes6 units2 more rows•Sep 13, 2018
What is the average number of therapy sessions?
Therapy has been found to be most productive when incorporated into a client's lifestyle for approximately 12-16 sessions, most typically delivered in once weekly sessions for 45 minutes each. For most folks that turns out to be about 3-4 months of once weekly sessions.Jul 29, 2019
How do you bill by time?
When documenting time, include only the time you spend face-to-face with the patient. If a nurse or other hospital member counseled the patient, you can not include it; you can count only physician counseling time. Your documentation needs to demonstrate that more than 50 percent of the visit was spent on counseling.
What is the CPT code for 15 minutes?
Use code 96168 for each additional 15 minutes. Code 96155 is now 96170 plus 96171: Code 96155 for a face-to-face family health behavior intervention without the patient present is now 96170 for the first 30 minutes. Use code 96171 for each additional 15 minutes.Feb 27, 2019
How many minutes is CPT code?
Report procedure codes for services delivered on any single calendar day using CPT codes and the appropriate number of 15 minute units of service. Services provided for a single timed CPT code that is less than 8 minutes should not be billed.Mar 15, 2021
How do you bill untimed codes?
Untimed codes are billed with a unit of one (1) per date of service. The unit for untimed codes is one regardless of how long the evaluation or service took. Providers should enter a 1 in the 'units bill' column per date of service.Apr 23, 2019
Does 97012 need a modifier?
Whether it's 97012 or 97140, by appending the 59 modifier, you will ensure that you receive reimbursement for both services.Jun 28, 2019
Is 97124 a timed code?
Therapeutic Procedures: CPT codes within the code ranges of 97110-97124, 97140, and 97530-97542 require direct (one-onone) patient contact by the provider. These codes contain a time component (15 minutes) and time is recorded based on constant one-on-one-attendance.
What is occupational therapy?
Occupational therapy is a professional field that employs assessment and intervention to develop, recover, and maintain the functions of everyday human activities. Occupational therapy evaluations typically include an occupational profile, patient medical and therapy histories, relevant assessments, and the development of a plan ...
What is an occupational therapy evaluation of low complexity?
An occupational therapy evaluation of low complexity requires these components: An occupational profile and medical and therapy history, which includes a brief history comprising a review of medical and/or therapy records relating to the presenting problem.
What is CPT code?
Certain current procedural terminology (CPT) codes are set by the American Medical Association to designate services provided by occupational therapists. All occupational therapists must have a thorough understanding of the procedure codes needed to run their practice efficiently and bill properly for the services they provide.
What is a modality in medical?
A modality is an application of electrical, thermal, or mechanical energy in order to induce physiological changes in patients. Modalities are often used to alleviate pain, improve circulation, reduce swelling, reduce muscle spasm, and deliver medications in conjunction with other procedures. CPT Code. Description.
What is a therapeutic procedure?
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. 97112. Neuromuscular reeducation of movement, balance, coordination, kinesthetic. Sense, posture, and/or proprioception for sitting and/or standing activities.
Does Medicare have a cap on therapy?
Medicare has a usage cap with therapy services. As such, documentation must show that the beneficiary qualifies of the therapy services justify a cap exception. Documentation must further show that services are reasonable, necessary, and require the skills of a therapist.
What are the problems with occupational therapy billing?
When claims are rejected, payment for services is delayed, robbing your practice of the operating capital it needs to thrive. Mistakes with coding can also result in incorrect information being added to a client’s billing record, being paid less compensation than you’re owed, or being flagged for an audit by an insurer. Here are some of the most frequently-made billing mistakes and how to steer clear of them.
How many tiers are there in occupational therapy evaluation?
Occupational therapy evaluation codes are broken into three tiers based on the level of complexity. Each one has a corresponding CPT code. An occupational therapy reevaluation has a single CPT code. Below is a brief snapshot of what an evaluation at each level would typically involve.
What is the 97110 CPT code?
The 97110 CPT code is one of the most frequently-used therapeutic procedure codes for occupational therapy. Knowing when to use this code, the documentation you’ll need to back it up, and when to use the 97530 CPT code instead will save you from potential billing headaches down the road.
What is upcoding in OT?
Upcoding — As the name implies, upcoding involves using a billing code that exceeds the patient’s current diagnosis or the level of treatment you provided.
What is the purpose of an assessment of a patient's occupational profile?
Analysis of the patient’s occupational profile and data from assessments is used to formulate a small number of treatment options. The evaluation requires a low degree of analytical skills to complete.
What is the ICd 10 code?
ICD-10 is a diagnostic tool developed by the World Health Organization. ICD-10 codes are used in the United States by medical and therapy professionals to document medical and treatment diagnosis. These codes must be included in insurance claim submissions along with related CPT codes.
What is the ICD-10 code for a therapist?
ICD-10 codes are highly specific, making it easier for therapists to select codes that describe the patient’s current impairment in greater detail. But many of these codes are quite similar, increasing your chances of incorrectly coding a diagnosis. Here are a few of the most common ICD-10 coding mistakes and how to avoid them.
What is the physical agent used in occupational therapy?
Physical Agent Modality: Ultrasound. Ultrasound (US) is a common physical agent modality used in Occupational Therapy. It involves an ultrasound unit and transducers. The ultrasound unit and transducer creates sound waves that penetrate tissues of the body, and causes vibrations of the molecules within the tissues receiving the sound waves.
What can a therapist manipulate?
Therapist can manipulate frequency, duty cycle, dosage, treatment duration, and treatment area to achieve different outcomes, such as non-thermal and thermal ultrasound. The transducer must maintain contact with the skin throughout the entire treatment session.
What to use to clean a transducer?
If rinsing is required, use caution not to expose the system connector to moisture or liquids. Use a lint-free soft and clean dry cloth or wipe to thoroughly dry the transducer.
Video training resources
Watch these short videos to learn more about coding and billing. And access the resources below for tips on how to select the right codes.
More videos about coding and billing
Watch these short videos to learn more about coding and billing. And access the resources below for tips on how to select the right codes.
Occupational therapy evaluation and re-evaluation codes
Coding is essential not only for proper reimbursement, but also because it is used as a tracking tool by CMS and other agencies to inform how occupational therapy is practiced. These tips will help you select the most appropriate evaluation codes.
Diagnosis coding resources
The ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system, replaced the ICD-9-CM (9th Revision) on October 1, 2015. AOTA developed the following resources to help occupational therapists deal with the continuing challenges of ICD-10-CM.
CPT (procedural) coding resources
These tips will help you select the most appropriate intervention codes.
NCCI edits
The Medicare National Correct Coding Initiative (NCCI; also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare Part B claims.
What is the role of an occupational therapy assistant in an intervention plan?
For an intervention plan, the occupational therapist must document the followinginformation in the patient medical record. The occupational therapy assistant maycontribute to the intervention plan; however, the final responsibility for the documentation,and the signature and credentials on the documentation must include that of theoccupational therapist.
How long has Rhonda been in rehab?
Rhonda, who had a stroke nine weeks ago, spent 12 days in aninpatient rehab facility before receiving treatment for the past five weeksin a skilled nursing facility. The 82-year-old, who is now under your care,lost her husband five months ago and is having a hard time coping; shepreviously was going to a support group, but now is unable to attend.Nowadays, Rhonda is staying with her 53-year-old daughter, whoprovides routine care and assistance. Rhonda, who’s legally blind andhas type 1 insulin-dependent diabetes, had a knee replacement a yearago and is presenting with short-term memory deficits as well asdecreased ability to complete tasks. She’s also presenting with muscleweakness, a hemiplegic gait pattern, and proprioceptive deficits on herright side. Due to increased physical and cognitive deficits, Rhonda canno longer perform household chores like vacuuming, dusting, and doinglaundry. These restrictions have forced you, the OT, to provideassistance and modify some of her evaluation activities during visitation.
Who must document a discharge summary?
The occupational therapist must document a discharge summary at the discontinuation ofservices. The occupational therapy assistant may contribute to the discharge summary;however, the final responsibility for the documentation and the signature and credentialson the report must include that of the occupational therapist.
How much ultrasound energy is needed for every treatment head?
The final compilation of the treatment dose which is most likely to be effective is based on the principle that one needs to deliver 1 minutes worth of ultrasound energy (at an appropriate frequency and intensity) for every treatment head that needs to be covered.
What are the advantages of ultrasound?
One of the advantages of ultrasound therapy remains the reasonably broad range of trials from which effective treatment doses can be established. In principle, there is no need for the often used 'recipe book' in which a list of conditions is produced alongside the treatment dose.
What pulse ratio is needed for acute lesion?
There is no need to increase the surface dose to allow for loss of ultrasound at depth. The lesion is acute, therefore a pulse ratio of 1:4 will be most appropriate.
How long is a 97712 treatment?
Example 1: 24 minutes of neuromuscular reeducation, code 97712. 23 minutes of therapeutic exercise, code 97110. Total timed code treatment time is 47 minutes. If you look up 47 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes).
How many minutes can you bill for untimed codes?
For example, it you spent 38 minutes on timed codes and 30 minutes on untimed codes, the maximum number of units you can bill for is 3 units (38 to 52 minutes) based on the table. Remember, you only count the timed code minutes and you must ignore the untimed code minutes.
How long is a 15 minute timed code?
For the individual codes, you need to code based on the following rules: If a service represented by a 15 minute timed code is performed in a single day for at least 15 minutes, that service shall be billed for at least one unit.
What is the time period for 97545?
The code 97545 is for the time period included in the first 2 hours and the code 97546 includes the time period for each additional hour (after the first 2 hours). Normally these codes are used to report services to a patient's Workers Compensation program and are only rarely used for Medicare.
How long is 97140?
7 minutes of manual therapy, code 97140. Total timed code treatment time is 40 minutes. If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). You can bill 2 units of 97110 and 1 unit of 97140.
How long can you bill for a 15 minute treatment?
Now, per Medicare’s 8-minute rule, you can bill for a full 15-minute timed treatment unit as long as you provided that service for at least 8 minutes, but as this blog post explains, it’s still imperative that you record the exact duration of each type of treatment you provide. 6.
How many billable minutes should I record?
Remember, when it comes to recording treatment time, almost doesn’t count; in other words, if you provided a particular timed treatment for 14 minutes, that’s how many billable minutes you should record. “Both treatment times and session times should be recorded to the exact minute,” this article states.
Why is billing for every minute of a patient visit a red flag?
In fact, billing for every single minute of a patient visit would be a serious red flag, because it would be nearly impossible for a therapist to run an entire session of pure, continuous billable time.
What should a therapist indicate in a soap note?
As for the documentation aspect, the therapist should be able to indicate the total visit time in the SOAP notes and also indicate the total direct time spent on each intervention. (If the therapist uses WebPT, there's actually a specific area in the SOAP note to make this distinction.)
How many units are in 40 minutes?
With that in mind, your total timed minutes (40 minutes) are equivalent to three (3) units (i.e., two 15-minute increments with a remainder of 10 minutes). You would then only bill one unit for the untimed code, which brings you to a total of four units.
Is documentation time billable for Medicare?
Documentation takes time—there’s no denying that. Even if you have an EMR system that streamlines the process, there’s still a lot of effort that goes into creating notes that are complete, correct, and compliant. Unfortunately, you won’t get paid for that effort, because as Pauline Watts, MCSP, PT, and Danna D. Mullins, MHS, PT, explain in this article, “Documentation time alone is not considered billable time under Medicare regulations.” The key word, however, is “alone”; the article goes on to explain that in some cases, you may be able to provide billable services at the same time you are documenting. Case in point: patient education, which includes any time dedicated to “discussing progress in therapy with the patient, including improvement in objective measures and how they are progressing toward their goals,” Watts and Mullins write. “If we are documenting this patient education information at the same time we are providing it to the patient, then this documentation time can be included in the treatment time.” One major caveat: the patient must actively participate in the conversation. That is, he or she cannot just sit passively and listen as you read or dictate your notes out loud. “Obviously not all documentation can be done in this manner and not all patients are appropriate to include in this educational process,” Watts and Mullins continue. “ [But the] practice of sharing the information with the patient has many extremely positive outcomes for the patient.”
Can a therapist bill Medicare?
Most payers, including Medicare, allow therapists to bill for the initial evaluations necessary to establish plans of care. (However, please note that, according to this ADVANCE article, therapists billing under Medicare Part A in a skilled nursing setting cannot bill for the “time it takes to perform the formal initial evaluation and develop the treatment goals and the plan of treatment cannot be counted as minutes of therapy received by the beneficiary.”)
