Wiki physician directed therapy

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Hi everyone, Is physician directed home exercise program considered an order for the new CPT guidelines?
The physician provides directions but not to another healthcare provider. Since I could bill a 97110 if any insurance would reimburse, does that make it count as an order?
 
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Are you wondering if you can count it in the Amount and/or Complexity of Data to be Reviewed and Analyzed section? If so, the new guidelines define a "test" as "Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (eg, basic metabolic panel [80047]) is a single test. The differentiation between single or multiple unique tests is defined in accordance with the CPT® code set." per AMA. Physician-directed home exercise really isn't a test per this definition.

Hope that helps!

Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS, AAPC MACRA Proficient
Head of Publishing, Editorial & Technology
AAPC
 
As a Chiropractic Physician of 23 years, and a newly minted CPC-A, I can tell you the 97110 is a physician directed therapy code to a patient. Whether the treating physician orders a PT, PA, PTA or other to do it with the patient, or the physician directly performs teaches /performs it with the patient, or patient performs the therapy, it is not to be bundled into the E&M codes. Because it has a CPT code it is to be separately billed., per the guidelines. Nothing has changed in regards to this with E&M, as far as I read. Remember, 97110 is a one on one, direct contact, per15 minutes code, so the threshold for a full unit is 8 minutes; importantly, Medicare does not allow reduced services (-52) to be billed to their recipients. Furthermore, the exercise plan should be documented as part of visit and why it is to be done.
Hope this helps.
Also, if others read this and have feedback for me, that would be helpful. Thank you.

Grant Shapiro, DC, MCS-P, CPC-A
 
Are you wondering if you can count it in the Amount and/or Complexity of Data to be Reviewed and Analyzed section? If so, the new guidelines define a "test" as "Tests are imaging, laboratory, psychometric, or physiologic data. A clinical laboratory panel (eg, basic metabolic panel [80047]) is a single test. The differentiation between single or multiple unique tests is defined in accordance with the CPT® code set." per AMA. Physician-directed home exercise really isn't a test per this definition.

Hope that helps!

Leesa A. Israel, BA, CPC, CUC, CEMC, CPPM, CMBS, AAPC MACRA Proficient
Head of Publishing, Editorial & Technology
AAPC
Do you know if it counts the same as PT orders for Risk of Complication?
 
Do you know if it counts the same as PT orders for Risk of Complication?
Not sure I understand correctly but, 97110 is therapy only. As long as >/= 8 minutes spent (1 full unit) with patient, you can bill the code. NOTE: 97110 does not include E&M, which can be billed by physician (99212/99213 type visit) in addition to 97110. So, the therapy code does not include MDM.
 
As a Chiropractic Physician of 23 years, and a newly minted CPC-A, I can tell you the 97110 is a physician directed therapy code to a patient. Whether the treating physician orders a PT, PA, PTA or other to do it with the patient, or the physician directly performs teaches /performs it with the patient, or patient performs the therapy, it is not to be bundled into the E&M codes. Because it has a CPT code it is to be separately billed., per the guidelines. Nothing has changed in regards to this with E&M, as far as I read. Remember, 97110 is a one on one, direct contact, per15 minutes code, so the threshold for a full unit is 8 minutes; importantly, Medicare does not allow reduced services (-52) to be billed to their recipients. Furthermore, the exercise plan should be documented as part of visit and why it is to be done.
Hope this helps.
Also, if others read this and have feedback for me, that would be helpful. Thank you.

Grant Shapiro, DC, MCS-P, CPC-A
I have so many questions about documentation from a providers point of view...I have been looking for samples of documentation for 97110/97114/97016. I am trying to help a provider improve their documentation but I can't find examples to use. Would you have a reference I could point them to??
 
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