How to Bill for Co-Treatments
In this article, I will answer the following questions regarding co-treatments in the outpatient therapy setting:
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To clarify on the last question of inpatient hospital therapy services, if an OT and PT co-treat for 30 minutes each of them may charge 2 units since reimbursement will be part of the DRG? In our hospital system for inpatient therapy we document and put in the appropriate CPT codes for the therapy we provide. From time to time we do co-treat. I have always told our therapists to split the time up like we do in outpatient. This hurts our “productivity” since we are not accounting for all of the time each therapist spends with the patient. Would it be incorrect to have them both put in units to account for their entire time spent since we are not actually being reimbursed for those CPT codes? It seems wrong even if we are not being reimbursed for them. I hope that makes sense. Thank you for your input.
I would tell you to follow the outpatient rules.
What is the source for the information below? Great info, but never seen this before. Thanks.
For example, for Medicare in 2023 for 92507, the total work time for 92507 is 60 minutes. This includes 5 minutes pre-evaluation time, 50 minutes of intraservice time, and 5 minutes of post-service time.
CY 2023 PFS Final Rule Physician Work Time
Hi Rick:
What is the source of these answers for us to reference in the future? It is interesting that commercial and private insurance blanket say that the time has to be split. I thought this was handled on a payer by payer basis. Thank you!
The definition of the CPT codes state “one-on-one”, not “two-on-one”. How can you bill a patient for 2 hours of therapy when they only had one hour of therapy?
I had received some different guidance regarding stretching of bilateral extremities. If a therapist is providing stretching and scar massage on the right arm and another therapist is providing the same treatment on the left and each billing 30 minutes that would be the same as one therapist working on both arms for an hour. The patient would not be receiving any additional billing but they would be able to have a shorter session. We always split the time if two therapists are required for a therapeutic activity or gait. What are your thoughts?
I would say to have one therapist do the treatment.
What about co-treats in the home health setting?
Home Health under Part A and a Home Health Agency plan of care is completely different billing and this article does not address that.
If therapists do a co-eval and treat, how would the time be split? For example, if a PT and OT see a patient for 45 minutes jointly and each completes an untimed evaluation and some treatment, what is the maximum number of total units that could be billed? Some staff want to bill an 8 minute PT eval, an 8 minute OT eval, and each discipline bill one unit of treatment with the remaining 29 minutes (for a total of 4 units). Is this possible? I thought 3 units would be the maximum that could be billed and I was worried about the weight of the evaluation codes… please advise.
I doubt a PT or an OT can do an evaluation in 20 minutes.
Yes. I concur. However, could I bother you to speak to the logistics of it? We are in an acute care hospital, but trying to comply with Part B billing guidelines. If it were possible to meet all of the requirements of an eval in that time, can you bill two untimed codes and two timed codes in 45 mintues?
I can’t answer as I doubt an eval can be done in 8 minutes. Also, for true acute care, you are paid via DRG’s and not per CPT code.