In last weeks article, “When to Bill For a Reevaluation”, I discussed when it would be appropriate to perform and bill for a reevaluation. In this weeks article, I want to teach you how to account for your time when you are gathering subjective comments from a patient or their caregiver as well as the time you spend gathering objective data to write a Progress Report that may be required by the insurance carrier (i.e. Medicare, Workers Compensation) or due to the patient having a return visit to their physician. To begin, there is no CPT code that exists to

I am frequently asked when is it appropriate to bill a reevaluation to an insurance carrier? Is it appropriate to bill when I am doing a Progress Report on a patient? Is it appropriate to bill for the purpose of completing a recertification on a Medicare patient? Is it appropriate to bill on the day I am also reporting the functional limitation reporting G-codes on a Medicare patient? In this article, I will answer the above 4 questions and provide you with the main criteria when a reevaluation would be appropriate to perform on a patient and bill to the

In last weeks article, I discussed two options for the billing of an orthosis to the insurance carrier, including the Medicare program. Those options were either the applicable L code for the orthosis or CPT code 97760 (orthotic management and training) for patient’s under an outpatient therapy plan of care. In this weeks article, I will discuss what practice settings can bill L codes to the Medicare program for orthotics provided under an outpatient physical or occupational therapy plan of care without requiring a durable medical equipment (DME) supplier number, which practice settings do require a DME supplier number to

Noridian Healthcare Solutions has notified providers of the initiation of a Service Specific Targeted Review on Skilled Nursing Facility (SNF) Resource Utilization Grouper (RUG) RU*. A service specific re-probe was completed for SNF RUG RU*. Errors were identified during this review, resulting in identification of the need to initiate a service specific targeted review. Click HERE to access the notice as well as the re-probe review findings.

In last weeks article, I discussed the difference between CPT codes 97760 (orthotic management and training) and 97662 (checkout for orthotic/prosthetic use). In the article, I explained how CPT code 97760 can include the assessment time, custom fitting or custom fabrication time associated with the orthosis, and the fitting of the orthosis to the patient if that time is not reported somewhere else. In this weeks article, I will discuss what the somewhere else is and when a L code may be appropriate to bill for a prefabricated, custom fitted or custom fabricated orthosis. So if you are not counting

On February 26, 2016, Cigna Government Services (CGS) published an article discussing required documentation for speech therapy services in the skilled nursing facility. When billing for speech therapy in the Skilled Nursing Facility (SNF) setting, the patient’s medical record must contain documentation proving medical necessity for the service. Patients who have been transferred to a SNF from a covered hospital stay must be treated in the SNF for conditions that were treated or arose during their qualifying hospital stay. If there is no indication that the patient received speech therapy during their hospitalization, speech therapy should not be billed by

The Noridian Provider Outreach and Education (POE) staff is hosting a Therapy Functional Reporting workshop on March 31, 2016 at 1 p.m. Central Time. This session includes: Inpatient Rehabilitation Facility (IRF) Services Documentation Requirements IRF Medical Necessity Criteria CERT and Medical Review Facts To sign up for this workshop or other workshops of interest, visit the Noridian Schedule of Events.

Two of the most confusing CPT codes that therapists and assistants ask me questions on, whether during a live seminar, a webinar, or just in an email question is, what is the difference between CPT code 97760 (orthotic management and training) and CPT code 97762 (checkout for orthotic/prosthetic fit) and what interventions would be included in each CPT code? Before I answer the question, let me provide the full CPT code description of each CPT code. 97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes. 97762