Test your Rehab Coding and Billing Knowledge
Test your Rehab Coding and Billing Knowledge
This quiz will tell you where you fall.
Want to stay refined on your coding and billing skills to make certain stellar reimbursement and compliance? Give this quiz a try and then turn to page 21 for the answers where the experts chime in with their two cents.
Questions:
1) Which of the following is an instance of a skilled and billable therapy service
A patient is exercising on a bike as you monitor him, and you code for therapeutic exercise (CPT 97110).
b) A patient is exercising on a bike as you actively coach the patient on technique and muscles he requires to strengthen to lessen knee pain. You report for therapeutic exercise (CPT 97110).
A patient is doing self stretching exercises for the shoulder by using the pulleys whilst you are carrying out manual therapy on another patient. 2) You get a new Medicare patient who requires occupational therapy for two unrelated diagnoses from different physicians. So how should you charge for your initial evaluation?
Put all under one evaluation code. Report 97003 once and go for modifier 76 (Repeat procedure or service by the same doctor)
Report 97003 twice, appending modifier 59 (Distinct procedural service).
Bill 97003 once if you are doing both evaluations on the same day; Bill 97003 twice if you do the evaluation on a different day. 3) What should you do if you are in a non-hospital outpatient setting, your patient exhausts a therapy cap, and she still requires skilled therapy services?
Bill for the services with the KX modifier, and see to it that you have documentation to support the medical necessity.
Make the patient go for an ABN form and have her agree to pay out of pocket.
Don't bill for further services. Allow the patient to pay out of pocket or refer her to the nearest hospital outpatient facility. 4) You carry out separate and distinct therapy procedures on one patient on the same day that fall under a column 1-column 2 CCI edit. What should you do? a) Append modifier 59 to one of the codes; it does not matter which one. b) Append modifier 59 to the column 1 code of the edit. c) Append modifier 59 to the column 2 code of the edit. 5) Your rehab department has speech therapy orders for a patient who is suffering from post-stroke dysphagia. What code should you report as the patient's primary diagnosis? a) 434.91 (Cerebrovascular accident) b) 438.x (Late effects of cerebrovascular disease) c) 438.82 (Dysphagia owing to late effect of cerebrovascular accident) and 787.2x (Dysphagia) 6) In the clinical setting, how should you charge for a TENS set up and application? a) 97014 or G0283 b) 97032 c) 64550Outpatient Billing, quiz answers: 1) Answer: B. Even if a code is reimbursable, say for instance 97110, you should bill it only for skilled services. Billing 97110 when you are just watching a patient will not fly as anyone can watch a patient.
"When choosing codes, remember that we're paid for what we're doing, not for what the patient is doing," says Ken Mailly, PT, of Maily & Inglett Consulting in Wayne, N.J. That apart, when you are deciding, for instance, between therapeutic exercise versus neuromuscular re-education codes, and the like, remember that you should bill for the intent of what you are delivering, he adds.
Note: You should bill for the patient education and training component of 97110. Once that is done, the rest of the time wouldn't be billable. 2) Answer: C. Medicare will not accept modifier 79 from a therapist as it is meant for physician services, and modifier 59 is not apt because this case is not a CCI edit. According to Rick Gawenda, PT, director of finance for Kinetix Advanced Physical Therapy, Inc. and President/CEO of Gawenda Seminars & Consulting, "If both evaluations are done on the same day, irrespective of the payer, bill only one unit of the evaluation CPT code since it is un-timed." "If carried out on separate days, the Medicare program will reimburse for a second evaluation for the second diagnosis." Joanne Byron, LPN, BSNH, CHA, CMC, CPC, CPC-I, MCMC, PCS, president and CEO of HCCS, Inc. in Medina, Ohio points out, Chapter 15 in the Medicare Benefit Policy Manual supports billing for two evaluations if a second condition arises during the episode of care. "After the second condition is evaluated, then the plan of care is adjusted to cover new treatments and everything is done under one plan of care, according to Medicare." Don't forget: "Most insurance providers follow Medicare guidelines, however not all," says Byron. As such check your patient's individual coverage guidelines. 3) Answer: C. The therapy cap exceptions process ran out at the end of year 2009. As such you can't bill for an exception with modifier KX. What's more, you are not required to issue an ABN form since services above the therapy caps are statutorily not covered under Medicare.
The Waltz its History and Development Lithium battery knowledge Origin And History Of Tea Article Directory - Targeted Free Traffic Is the Best Traffic Collectable Books for the Discerning Antiquarian Know Where To Find Accurate Biology Answers And Enhance Your Knowledge In Life Science History Of The Belt Buckle Ultimate Book Of Bootcamp Workouts Critiques CarTown Facebook Change The Story - Advice For A Broken Heart Gold Trading History The History Of Enrolled Agents FFXIV Guide, Articles and Information Source