provided by coventry health care usual & customary medical bill reviewer training program unit...
TRANSCRIPT
Provided by Coventry Health Care
Usual & Customary Medical Bill Reviewer Training
Program
Unit 1: Professional Services
Module 8: Physical Medicine & Manipulation
©2011 Coventry Health Care. All rights reserved.Proprietary – Do not copy, distribute or disclose without permission of Coventry
Health Care
Usual and Customary Training – Physical Medicine July 2011
Overview
Hi! In this module, you will learn about physical medicine, acupuncture, and
manipulation. Let’s first take a look a
Physical Medicine…
Part I: Physical Medicine Physical Medicine Guidelines Patient Evaluation Acupuncture Manipulation
Part I: Physical Medicine Physical Medicine Guidelines Patient Evaluation
Usual and Customary Training – Physical Medicine July 2011
Physical Medicine Guidelines
Physical medicine focuses on the diagnosis, treatment, and prevention of illness or injury by physical means.
The physical medicine section
ranges from 97001-97799. Let’s take a look…
Usual and Customary Training – Physical Medicine July 2011
Physical medicine also involves services such as:
Physical Medicine Guidelines
Physical medicine services encompass many different types of treatment.
Physical medicine includes the use of:
Light Heat & Cold Water Electricity Mechanical Apparatus Massage
Assessment & Evaluation
Work Hardening
Usual and Customary Training – Physical Medicine July 2011
Patient Evaluation
Just like other types of services, physical medicine patients undergo an evaluation to assess the nature and extent of an injury.
Physical TherapistsOccupational Therapists
Athletic Trainers
Physicians
Physical Medicine Evaluation Codes
E & M codes
The type of code used to bill for
evaluation services depends on the type
of provider.
Additionally, there are medicine codes
for tests and measurements
that can be billed.
These may include things like: range of motion testing• functional capacity testing •
muscle testing
Usual and Customary Training – Physical Medicine July 2011
Work Hardening
Part II: Other Services Work Hardening Acupuncture Osteopathic Manipulation Chiropractic Manipulation
Work hardening programs are
common methods of treating work-related injuries. Let’s take a
look...
Usual and Customary Training – Physical Medicine July 2011
Work Hardening
Work hardening is an individualized, goal-oriented program that assists an injured worker re-adjust to the physical demands of a job.
The American Physical Therapy Association states that work hardening improves:
Strength Endurance Movement
...related to the performance of work tasks.
Flexibility Motor control Cardiopulmonary
capacity
Each program typically includes conditioning exercises and simulated work activities tailored to the patient.
Usual and Customary Training – Physical Medicine July 2011
Work Hardening
Work hardening programs may include services from several specialties.
Work hardening programs may include a: Rehabilitation specialist Treating physician Psychologist Vocational rehabilitation
specialist
Usual and Customary Training – Physical Medicine July 2011
Work Hardening
There are several things you should be aware of when reviewing charges for work hardening.
2. Work hardening is reimbursed according to
time increments. All services performed within a specific length of time are
included in the charge, and should not be reimbursed
separately.
1. Physical therapy provided in combination with the work hardening
program, such as a “warm-up” or “cool-down,” is considered part of the
program and is not separately reimbursable.
3. Work hardening programs
typically last for more than a few
hours.
Usual and Customary Training – Physical Medicine July 2011
Work Hardening
Many physical therapy groups bill for work hardening when performing a lot of varied procedures and modalities, not an actual program.
How might you identify whether physical
therapy charges were for work hardening
program?
That’s right! You can verify this
information by reading the documentation.
Usual and Customary Training – Physical Medicine July 2011
Acupuncture
Let’s take a look…
Acupuncture services are subject to
guidelines as well...
Usual and Customary Training – Physical Medicine July 2011
Acupuncture
Acupuncture involves the stimulation of specific points on or near the surface of the body in order to treat a patient for pain, as well as diseases and disorders of the body.Acupuncture codes include:
CPT 97810: without electrical stimulation – initial 15 minutes
CPT 97811: without electrical stimulation – each additional 15 minutes
CPT 97813: with electrical stimulation - initial 15 minutes
CPT 97814: with electrical stimulation – each additional 15 minutes
Acupuncture codes = 15 minute increments
Usual and Customary Training – Physical Medicine July 2011
Acupuncture
There are a few guidelines that you should be familiar with when reviewing charges for acupuncture services:
Time = Face to face time, not the time needles are in place.
Only 1 initial code may be
billed per visit. All additional
time coded with 97811 or 97814.
Office visits are included with
acupuncture unless modifier -25 is
attached. Documentation must
show significant, separately
identifiable E/M services performed.
Usual and Customary Training – Physical Medicine July 2011
Osteopathic Manipulation
Osteopathic Manipulation Chiropractic Manipulation
Lastly, we will discuss osteopathic
and chiropractic manipulation
services...
Usual and Customary Training – Physical Medicine July 2011
Osteopathic Manipulation
Osteopathic manipulation focuses on correcting body mechanics and structural abnormalities to treat illness, injury, and disease.
Osteopathic Manipulation codes range
from 98925 – 98929.
Osteopathic manipulation codes are: Limited to Doctors of Osteopathy
(DOs) and Doctors of Medicine (MDs).
Osteopathic manipulation
procedure codes depend on how
many body regions are manipulated.
Let’s take a look…
Usual and Customary Training – Physical Medicine July 2011
Osteopathic Manipulation
Body regions include:
Cervical Region
Thoracic Region
Lumbar Region
Sacral Region
Head Region
Rib Cage
Lower Extremities
Upper Extremities
Abdomen & Visceral Region
Pelvic Region
Usual and Customary Training – Physical Medicine July 2011
Chiropractic Manipulation
Let’s take a look…
In addition to osteopathic
manipulation, there are chiropractic
manipulation procedures.
Usual and Customary Training – Physical Medicine July 2011
Chiropractic Manipulation
Chiropractic manipulation focuses on the improvement of joint and neuro-physiological function.
Chiropractic Manipulation
codes range from 98940 – 98943.
Chiropractic manipulation codes not only depend on
the number of body regions
manipulated, but which body region
as well.
Usual and Customary Training – Physical Medicine July 2011
Chiropractic Manipulation
For CPT 98940 through CPT 98942, regions include:
Cervical Region
Thoracic Region
Lumbar Region
Sacral Region
includes atlanto-occipital joint
includes costovertebral and
costotransverse joints
Pelvic Region
Now let’s take a look
at CPT 98943...
*Only the most extensive code is allowed to pay.
Usual and Customary Training – Physical Medicine July 2011
Chiropractic Manipulation
Head Region
Rib Cage
Lower Extremities
Upper Extremities
Abdomen
For CPT 98943, the following regions apply:
includes temporomandibular joint
excludes atlanto-occipital joint
excludes costotransverse joint
excludes costovertebral joint
Usual and Customary Training – Physical Medicine July 2011
Office Visits with Manipulation
If osteopathic or chiropractic manipulation is billed, can E/M also be billed?
Modifier -25 must be attached to the office visit codeDocumentation must show significant separately identifiable E/M services were rendered.
Manipulation codes are keyed as billed
Yes!
Usual and Customary Training – Physical Medicine July 2011
Summary
How work hardening and acupuncture services are reimbursed.
Physical Medicine: General Guidelines
Osteopathic and chiropractic services.