Documentation Tip: An Essential Element for Physical Therapy Claims

Documentation Tip: An Essential Element for Physical Therapy Claims

Physical therapy has made it in the Office of Inspector General’s (OIG’s) work plan for several years running. With medical reviewers on the lookout for high utilization of outpatient physical therapy services, coders and billers need to be vigilant about how their physical therapists are documenting services.

Per Chapter 15, Section 220.1.1 of the Medicare Benefit Policy Manual, payment for physical therapy is dependent on the certification of the plan of care for the patient receiving services. A signed and dated order is acceptable as certification if it meets the requirements of the plan of care.

A valid plan of care for physical therapy, occupational therapy, or speech-language pathology services prescribes the:

  • Type,
  • Amount,
  • Frequency, and
  • Duration of services.

A diagnosis and anticipated goals that are consistent with the patient function reporting on claims for services must also be in the plan of care.

Bottom line: Medicare Part B only pays for therapy services if a physician, or other non-physician practitioner with knowledge of the case, signs and dates the care plan as soon as possible (within 30 days of the initial therapy treatment). Without this information, claims will be denied due to insufficient documentation.

 


 

Source: Medicare Learning Network, Medicare Quarterly Provider Compliance Newsletter: Guidance to Address Billing Errors, Volume 5, Issue 1, October 2014

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.
Renee Dustman

About Has 525 Posts

Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.

2 Responses to “Documentation Tip: An Essential Element for Physical Therapy Claims”

  1. Kelley says:

    How often must the order for PT be updated? Is it good as long as the patient remains in continuous therepy?

    Thank you!

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