Like other specialties, physical therapy (PT), as well as occupational therapy (OT), have special billing and coding hurdles to overcome. It is not enough to get defensible documentation; you also have to understand the guidelines that all payers follow for their time-based reporting. They also need to make sure they are counting properly. Here is what you can do to help your physical therapy and occupational therapy practices stay in good shape.
Document the Complexity of Your Occupational and Physical Therapy Evaluations
CPT codes specify three levels of complexity: low, moderate, and high. Providers must know, as well as document, all of the elements that support every designation. You can use your CPT manual to help you. For more stratified codes, you also need to think about the possibility of upcoding them. Without all of the right components, providers may face denials and/or audits.
Specify Areas of the Body
Part of physical therapy involves documenting which muscles and joints received treatment. It makes it easier to justify the CPT codes that ask for therapy to be done on one or multiple parts of the body. On top of that, it makes it easier for payers to understand injuries that helps them assign liability.
Carefully Count Your Units of Time
The first thing you should do is find out if your payer makes providers put time-based services altogether or if they report all of their time-based codes independently of each other. Also, keep in mind that the CPT Manual says that a unit of time takes place once the provider gets past the halfway point of any time-based service. For physical therapy and occupational therapy, the halfway mark is at eight minutes.
Know When to Apply Modifier-59
Modifier-59 can apply in either an occupational or physical therapy specialty whenever a provider performs two separate time-based procedures at two separate times during the same day. Providers should never bill time-based codes for multiple patients simultaneously unless they can prove that those services were done at separate times, or that they were done with help from either an occupational or physical therapy assistant who can be recognized as a reimbursable provider as stated in the payer contract.
Review the Referral and Utilization Before You Render Treatment
Ask yourself if the diagnosis ordered for the occupational or physical therapy is in line with the patient’s current diagnosis. If it is not, the therapist might have to clarify the diagnosis so that it is able to justify rendered treatment. The treatment plan that is administered needs to be necessary for the patient’s diagnosis. Do not give out prolonged treatment for the sole purpose of bringing in more revenue.
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