With the implementation of the new physical and occupational therapy evaluation codes with dates of service on and after January 1, 2017, I am receiving many questions what do I think is the proper billing when a patient is referred to either physical therapy or occupational therapy for the purpose of a wheelchair evaluation. In this article, I will answer this question from 2 perspectives. I will provide the answer for a one-time only wheelchair assessment and also provide the answer for when a full evaluation is required.
First, we need to provide the CPT code and description for wheelchair management. Per the American Medical Association, CPT Professional Edition, 2017, CPT code 97542 is defined as follows: Wheelchair management (includes assessment, fitting, training), each 15 minutes. According to CPT Changes 2006: An Insider’s View, assessment includes, but is not limited to,
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Per this statement in the article, Wheelchair management (includes assessment, fitting, training), each 15 minutes. According to CPT Changes 2006: An Insider’s View, assessment includes, but is not limited to, documentation of the event…
Are you saying that time spent documenting can be included in the billing?
In my opinion, documentation time is not billable time. Also, keep in mind, I am not saying anything. I am just providing the AMA reference and what they state.
We have seen a patient for a wheelchair assessment while the patient was under a home health plan of care.
Medicare says the HH agency must reimburse us. However, the HH agency says there is a modifier that we use that shows the wheelchair assessment is related of the HH plan of care.
I see a modifier GW for a services not related to a hospice plan of care but not home health.
No as I am not aware of any special modifier.