Eli's Rehab Report
Maintenance Therapy Doesn't Pay
PDF
Question: Our office manager thinks that our therapist's gait training documentation refers to "maintenance therapy" and therefore isn't payable, but the therapist disagrees. How can we determine the difference between maintenance and non-maintenance therapy?
Tennessee Subscriber
Answer: If your patient has already met all of her rehabilitation goals and no longer shows any progress, your carrier will probably consider the gait training "maintenance" and refuse to pay.
According to the policy of Blue Cross and Blue Shield of Tennessee, gait training is a skilled service (and therefore may be payable) "if the patient's ability to walk has been impaired and when training can be expected to significantly improve the patient's ability to walk."
The carrier considers gait training non-skilled "after the gait has been taught and the goal is merely walking to improve distance or endurance."
Some payers, including Tennessee's, will reimburse maintenance for periodic evaluations to determine whether the patient has responded well to treatment, but these services are payable only on a case-by-case basis.
If you believe you perform skilled therapy but your office manager disagrees, you might not be documenting your services thoroughly enough. Be sure to record the patient's diagnoses, symptoms and impairments and how the gait training helps her improve her condition.
Eli's Rehab Report
- NCCI 10.1 Edits Could Cost You More Than $120 Per Test
16 testing codes are now bundled into scores of spinal injection codes If your physiatrist [...] - Forget Separate Payment for Therapy Evals, Orthotics Codes
New NCCI edits bundle 97755 into 21 other codes If you're billing the new assistive [...] - 3 Tips Help You Choose Among Modifiers -59, -76 and -77
Hint: -76 and -77 signal repeats, while -59 refers to a different procedure You aspirate [...] - You Be The Coder:
Modifier -50 and 95900 Don't Mix
Question: Should we append modifier -50 to 95900 when we perform bilateral testing for carpal [...] - Want to Make an Extra 15% Each Time You Report 99213?
5 requirements get you 100 percent nonphysician-practitioner reimbursement If a nonphysician practitioner (NPP) ever performs [...] - Reader Question:
Whirlpool Alone Is Justifiable for Wound Care
Question: We often use whirlpool to help cleanse patients' wounds. Our carrier recently told us [...] - Reader Question:
Appeal Modifier -25 Denials
Question: Whenever I use modifier -25 on an E/M service with a procedure code on [...] - Reader Question:
Maintenance Therapy Doesn't Pay
Question: Our office manager thinks that our therapist's gait training documentation refers to "maintenance therapy" [...] - Reader Question:
Append -32, but Don't Expect More Money
Question: Our physiatrist spends a lot of time on confirmatory consultations that insurers request, which [...] - Reader Question:
Don't Let Patient's Age Drive Diabetes Diagnosis
Question: Our rehab physician recently saw a 16-year-old motor-vehicle accident patient with underlying diabetes. We [...]