Part B Insider (Multispecialty) Coding Alert

Published on Thu Jan 10, 2008 PDF

If PT's notes don't match CPT, differentiate between acronyms and separate procedures

With practices rejoicing about Congress- six-month moratorium on Medicare's 2008 therapy cap, it's a good time to catch up on the latest therapy billing advice.

Coders who are frequently faced with charts containing such procedures as myofascial release, music therapy and magnet therapy may not know whether they can collect. But if they first determine whether the modality is simply a synonym for a procedure that CPT describes, they-ll be on the right track.

As most practices know, you can never report a code that is -close- to a CPT code. If no code describes your service, you should instead choose an unlisted code. But if, for example, your therapist documents arm lifts using a rubber band for resistance, you probably know to report 97110 (Therapeutic exercises) for this service, even though the PT didn't specifically document the words -therapeutic exercises.-

In that same vein, some other therapy services fall under the umbrella of existing CPT codes, and we-ve got the scoop on which are billable.

Myofascial release: If the therapist's chart reads, -Myofascial release,- your practice may be stumped about how to report it because CPT doesn't include a specific code for this service. Keep in mind, however, that most Medicare carriers do allow you to report this service by using 97140 (Manual therapy techniques).

For example, the LCD for Part B carrier National Government Services states that myofascial release -may be medically necessary for treatment of restricted motion of soft tissues in the extremities, neck, and trunk- and recommends billing 97140 for this service.

Music therapy: Music therapy is a broad term for a number of activities performed while patients listen to music. The goals are to increase self-image and body awareness, and develop better communication skills and fine and gross motor skills. Nonethe-less, some therapists still list -music therapy- on their charts, and finding the right code can be difficult.

Depending on what the therapist and the patient are doing during the music, the activity may not be a modality that payers consider medically necessary, says Larkin Gruss, PT, a therapist in Boston. Some-times recreational therapists in nursing homes use music to assist patients to interact with peers or to increase attending behavior or simply moving around. This, however, is not normally billable or medically necessary, she says.

Some music therapy can be associated with a payable code, provided it enhances a valid therapy that the patient performs, Gruss says. The focus should be on the activity being performed during the music. Many times, the music is there to provide a tempo to help patients with their therapy.

For example, some therapists will play a march during therapeutic exercises if they want the patient to perform a series of knee lifts fairly quickly. You would code this using 97110. Other times, the therapist might have a group of four patients who work together to provide resistance during slow arm-strengthening exercises. To keep the patients from performing the task too quickly, the PT may play a sonata to keep them moving slowly. You would code this as group therapy using 97150.

Magnet therapy: Many therapists perform magnet therapy to help realign the body's energy using positive and negative magnet polarities. -It can help patients achieve proper magnetic alignment,- says Thomas Sherrick of Sherrick Billing on Long Island, N.Y.

-There is no code for magnet therapy,- Sherrick says. If you have to assign a code to this service, the unlisted therapy codes (97039, 97139 or 97799) are the most appropriate, depending on which of the three codes the PT finds the most accurate based on the documentation.

-As a rule, Medicare does not cover magnet therapy, but if the patient insists that you report the service, ask him to sign an ABN, and assign modifier GY (Statutorily excluded) to the unlisted code,- Sherrick says.