PT/OT units

iowagirl77

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Our physical and occupational therapists do their own coding, but I review denials. Most of the information I can find limits the number of units by the total time. They have been billing any services performed for at least 8 minutes. So for example they did 3 different services for 8 minutes each. Under CMS rules that is 24 minutes so we can only bill 2 total units. My providers are billing 3 units unless it is a Medicare/Medicaid/federal plan. When I asked about it, I was given this link: https://newgradphysicaltherapy.com/8-minute-rule-vs-spm-losing-money/

I asked around and none of the coders with therapy experience were familiar with the Substantial Portion Methodology (SPM). I can only find references that come back to this one source/author. It appears to be the way things were calculated before the 8-minute rule came about, but this article is from 2017 and says it can be used with any plan that hasn't adopted the CMS rule from 2000.

Thoughts?
 
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sistersarah

I am currently in the same boat. I code the Professional side in a hospital setting and we acquired a new PT/OT group that utilizes SPM for calculating units for each therapy procedure. I researched APTA and could not find anything, asked my OHS PT/OT group and they too had never heard of this but these new therapist swore by it. I have requested documentation and specific guidelines that they have to support this and I'm currently waiting for that, this is helpful and I will follow-up here if I have anything to add.
 

Lunap99

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sistersarah

I am currently in the same boat. I code the Professional side in a hospital setting and we acquired a new PT/OT group that utilizes SPM for calculating units for each therapy procedure. I researched APTA and could not find anything, asked my OHS PT/OT group and they too had never heard of this but these new therapist swore by it. I have requested documentation and specific guidelines that they have to support this and I'm currently waiting for that, this is helpful and I will follow-up here if I have anything to add.
I had a therapist point out the SPM to me when I started removing units from their bills. The SPM would only be applicable to commercial plans and each payer will individually decide which method they can choose to follow. For the most part, plans follow the 8-minute rule. So, when counting total units, I always go by 8-minute rule. If they have too many units, I will look and see if it a commercial plan then I switch to the SPM. We have not been getting denials back since I started coding for this group in June.
I did also take the time to ask MODA which method they utilize and was told that they go by the 8-minute rule for Medicare, Medicaid and commercial plans.
There are some really good articles about this on WebPT.com
 
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