Eli's Rehab Report

Published on Wed Apr 06, 2005 PDF

Individual therapy may occur continuously or in notable episodes.

You've taken the challenge. Now see how your coding skills measure up.

(1) Individual therapy, says Maria Johnson, CPC, a coder at Medaphase, Inc. in San Antonio, Texas. Medicare Part B instructs PTs "one-on-one minutes may occur continuously or in notable episodes." Part B also says that when a therapist provides direct one-on-one contact for the patient, then you should report this as individual therapy.
 
(2) Group therapy. "The question states two ore more patients and doesn't include 'one-on-one' contact," Johnson says.

(3) Group therapy, says Jacqueline Martinez, office administrator at Annie Black PT & Rehab PC in Forest Hills, NY. You'll know that you should choose this option because you read "intermittent personal contact to three patients." Two or more means group therapy.

(4) Individual therapy, Martinez says. This scenario included direct one-on-on contact.

(5) Group therapy. "If the therapist divides attention between patients, then you should bill each patient with one unit of group therapy (CPT 97150 )," Johnson says.

Note: You can find further clarification in the guidelines set forth by the American Physical Therapy Association as established by the Centers for Medicare and Medicaid Services, Martinez says. Specifically, these guidelines are clarified in the Carriers Manual Transmittal 1753.