PT Coders: Clinging to MD Approval

PT Coders: Clinging to MD Approval

PT Coders: Clinging to MD Approval

PT coders: Clinging to MD approval? Take a look at this Question: According to our hospital billing and Medicare departments, diagnoses we add to a claim for reimbursement must have a physician endorsement. We have researched our Local Coverage Determination ((L26884) from National Governement Services, the Ingenix Coding & Payment Guide for the Physical Therapist, and our Indiana Practice Act but cannot find a conclusive reference stating a physical therapist can make a treating diagnosis with an MD's endorsement. Our billing department suggested we send all POCs to the MDs for co-signature. However we would rather not increase the paper flow to the MDs.

Can you offer a reference that says PTs can make treating diagnoses that can stand alone minus the MD endorsement?

Answer: Asking the same question back to you, have you found a reference that states PTs cannot make treating diagnoses that can stand alone for claims submissions, medical records and the like without the MD? More so, you will not find a reference stating guidance either way. Your best bet is your state chapter organization and the American Physical Therapy Association.

Page 14 of the following link from the CMS offers more details: www.cms.hhs.gov/manuals/downloads/clm104c05.pdf. According to it, "Bill the most pertinent diagnosis. As usual, when billing for therapy services, the ICD-9 code that best relates to the reason for the treatment shall be on the claim, unless there's a compelling reason.

The manual then provides an example of a patient with diabetes being tended to for gait training because of amputation. According to CMS, "The preferred diagnosis is abnormality of gait (which characterizes the treatment)." "Where it's possible in accordance with state and local laws as well as the contractors LCDs, avoid using vague or general diagnoses."

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