Orthopedic Coding Alert

If you overhear your practice's physical therapist asking a patient how she's doing, it might not be idle chitchat. You can often count the pre-exercise time your therapist spends evaluating the patient toward the timed therapy codes (97032-97546).

 Many therapists are selling their practices short by billing only for the time spent performing the actual modality, says Pauline Watts, MS, PT, cofounder of Encompass Education Inc., a rehabilitation education and consulting firm in Palm Harbor, Fla. "The therapy skill is not just the hands-on skill," she says. "The American Physical Therapy Association says that the skilled care you perform from the moment you start with the patient is included in the therapy code. You are doing skilled care when you ask the patient how they've been doing, assess their condition and educate them on new exercises to do at home."                             

For instance, your therapist greets a hip-replacement (27130) patient who requires therapy to correct gait abnormalities. The following takes place during the patient's visit:    
A. The therapist talks to the patient for five minutes about his activities at home, and asks questions about how many stairs he has to climb each day, the height of his bathtub, whether he walks his dog, etc    
B. The patient spends five minutes changing into an appropriate therapy outfit.    
C. The patient performs 25 minutes of gait training and 25 minutes of therapeutic exercise.
D. The therapist spends five minutes teaching the patient how to perform specialized exercises at home to practice before his next therapy session.
E. The patient leaves the room to get changed again while the therapist spends 10 minutes documenting the visit in her records.

The therapist spent 60 billable minutes with the patient. You should add the five minutes prior to the session (noted in "A" above) to the 25 minutes of gait training, therefore totaling two units of 97116 (Therapeutic procedure, one or more areas, each 15 minutes; gait training [includes stair climbing]).

Add the five minutes post-gait training (noted in "D" above) to the therapeutic exercise time, totaling two units of 97110 (... therapeutic exercises to develop strength and endurance, range of motion and flexibility).

The time noted in "B" above, when the patient leaves the room and changes into a different outfit, does not count toward the therapy time, even if an aide helps the patient, Watts says. "You should also not count the time the therapist spends writing in the record, documenting the visit, talking to physicians, etc., toward the timed codes, since this has already been factored into the amount set for the reimbursement for these codes."                                                                        

If therapists happen to assess the patient while writing in the record, "they can count that as part of the time because they're getting paid for the assessment, not the documentation," Watts says, "but you have to be very careful to count only the time you're performing actual patient assessment."

You Can Count Less Than 15 Therapy Minutes

Most orthopedic practices agree that therapy billing would be infinitely easier if therapists'sessions always totaled 15 minutes (or increments thereof). But in the real world, therapists'visits rarely equal exactly 15 minutes. Unfortunately, many practices are writing off sessions lasting less than 15 minutes, but you can bill any therapy modality totaling eight minutes or more.

According to CMS Program Memorandum AB-00-14, released in March 2000, the chart on page 20 applies to practitioners billing the timed codes.

The program memorandum states that you should not report any service that lasts less than eight minutes. And "this is a CMS guideline, so the various carriers may use their own interpretation of it," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for the CRN Institute, an online coding certification training center. Therefore, confirm that your payers are using the same scale before you report timed units.

Example one: Apatient had a motor-vehicle accident and required a left-leg cast. Following cast removal, the patient had left-leg atrophy, requiring considerable therapy to strengthen it to resume prior functional status. The physical therapist begins the patient's session with a hot pack on the patient's left leg for six minutes, after which the patient complains of pain, and the therapist removes the pack. The therapist then leads the patient as he performs 27 minutes of therapeutic exercises, 22 minutes of gait training and 12 minutes of whirlpool.                               

Jandroep recommends coding this session as follows: