CPT Code for Physical Therapy Evaluation and the Functional Limitation G Codes for Medicare Claims
Mar21

CPT Code for Physical Therapy Evaluation and the Functional Limitation G Codes for Medicare Claims

CPT Code for Physical Therapy Evaluation is CPT Code 97001 Remember your CPT Code for Physical Therapy Evaluation 97001 must only be billed once per condition, per episode and per problem with 1 unit. It is a Faced-to-Faced Encounter, non-time based and no matter how long you spent time with the patient, you will still bill one unit for CPT Code for Physical Therapy Evaluation. I wrote this article about the PT Evaluation code plus the Functional Limitation G Codes that you must submit with your claims for Medicare. This article is based on Medicare Processing Manual Revised 2859 Issued 01-17-2014, Effective 01-01-2014 and with an Implementation Date of 01-31-2014. As of this writing, the guideline is still the same. Functional Reporting ( see reference – Rev. 2859, Issued: 01-17-14, Effective: 01-01-14, Implementation: 01-31-14) Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) amended Section 1833(g) of the Act to require a claims-based data collection system for outpatient therapy services, including Physical Therapy (PT), Occupational Therapy (OT) and Speech-Language Pathology (SLP) Therapy services. WHY? I think that this is going to be a big help in research and data gathering. Because what it does is that, the system will collect and gather data on beneficiary function during the course of therapy services in order to better understand beneficiary conditions, outcomes, and expenditures. These Functional G Codes are being reported using 42 NON-Payable functional G-codes and seven severity-complexity modifiers on claims for PT, OT, and SLP services. Meaning, they are only used for data gathering. And that is functional reporting on one functional limitation at a time is required periodically throughout an entire PT, OT, or SLP therapy episode of care. The nonpayable G-codes and severity modifiers are used for information gathering purposes about the patient or beneficiary’s functional status at the outset of the therapy service episode of care, including the status of projected goals, at specified points during treatment, and at the time of discharge. I honestly like these functional limitations reporting! These G-codes, along with the associated modifiers, are required at specified intervals on all claims for outpatient therapy services, not just those over the cap. Therapy Billing Services covered with this new rule Date of Service on or after July 1, 2013, that does not have the required functional G-code and modifier information will be returned or rejected. Date of Service prior are in testing phase. So as I am writing this post, rest assured that anything after July 1, 2013 must have your G-codes appended. I make sure my CPT Code for Physical Therapy Evaluation must be reported with G-codes on...

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Therapy Practice Management Software with the Understanding of 8-Minute Rule Therapy Billing
Mar15

Therapy Practice Management Software with the Understanding of 8-Minute Rule Therapy Billing

Therapy Practice Management Software For my 18 years in Medical Practice Industry, I know how critical it is to choose your best therapy practice management software. Most of my clients would ask me if I can recommend to them one particular therapy practice management software that they can use in their practice either it is cloud-based or having their own server in the office. Quite honestly, it is more important for you to understand how to properly and ethically bill for therapy services. And it is really important that the therapists understand the simple 8-Minute Rule for therapy billing purposes. No matter how great your therapy practice management software is, it is still up to the therapy billing strategies you can measure success and run a profitably therapy office. I always advise my clients that everything you render is always based on Medical Necessity and you must (imperative) document your services in a timely manner – real time I must say. So one of the important features of an excellent therapy practice management software is having a user-friendly, compliant and complete EMR Documentation feature integrated into the software. You don’t want headache and much more you don’t want to learn a lot more of things (the not-so computer savvy will have a problem unfortunately). So let’s focus on this post on understanding the 8 minute rule for therapy billing. When you understand this concept, you will be excited how to find the best therapy practice management software. Believe me, a lot of Therapy Billing Offices and Therapists themselves doesn’t fully understand the 8 minute rule. This is a very simple rule. Are you ready? Searched Key Phrase: Therapy Practice Management Software Let me show you how the 8 Minute Rule for Physical Therapy Billing Works based on Medicare’s Guidelines: The 8 Minute Rule Physical Therapy Billing for Practice Management Therapists. Let’s try to understand this 8-minute rule. Looking at our codes first; do you know what are your modalities? (there are a variety of therapy billing modalities that can help strengthen, relax, and heal muscles for patients requiring therapy billing services – may include electrical energy, thermal, light or mechanical agents/supplies/equipments) There are 2 types of Modalities, the Constant Attendance Modality and the Supervised Modality 1. Constant Attendance Modality (billed in 15 minutes increments) – REQUIRES direct one-on-one provider to patient contact. 97032 – Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes 97033 – Application of a modality to 1 or more areas; iontophoresis, each 15 minutes 97035 – Application of a modality to 1 or more areas; ultrasound, each 15 minutes 97039 –...

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