Billing

Question 1

CPT stands for

Answer 1

Current Procedural Terminology

Question 2

2 types of CPT codes

Answer 2

Time based (billed in time increments). Service based (1x/service. only 1/day).

Question 3

Time based codes include

Answer 3

Patient set up
Equipment set up
Review of medical records or previous documentation with the patient
Reviewing risks/benefits of intervention
Discussions with patient regarding treatment and their current status.
Performance of procedure
Medically indicated rest periods
Routine measurements
Discharging patient from treament.
Post treatment instruction with patient and/or caregiver.

Question 4

97161

Answer 4

Low complexity PT Eval. Service based code. No personal factors/comorbidities, addressing 1-2 elements of body systems, stable clinical presentation. 20 min guideline

Question 5

97162

Answer 5

Moderate complexity PT evaluation. Service based code. 1-2 personal factors/comorbidities, addressing 3 elements of body systems,evolving clinical presentation. 30 min guideline

Question 6

97163

Answer 6

High complexity PT evaluation. Service based code. 3+ personal factors/comorbidities, addressing 4+ elements of body systems, unstable clinical presentation. 45 min guideline

Question 7

97164

Answer 7

Physical therapy re-evaluation. Service based code. Not routine assessement. Only when there is significant change in patient’s status or long term goals. Hospitalization, new injury, re-injury, signficant improvment or decline in function

Question 8

PT evaluation components

Answer 8

Patient history, examination of body systems, clinical presentation, clinical decision making

Question 9

History

Answer 9

Comorbidities, PLOF, personal factors (age/sex/education/past experience/profession/coping styles), behavior patterns, other factors that influence how disability is experienced by individual.

Question 10

Body Systems

Answer 10

Musculoskeletal system (ROM, MMT, etc)
Neuromuscular system (balance, coordination, gait, etc)
Integumentary system (scar formation, skin color/integrity etc)
Cardiovascular/pulmonary (HR, BP, etc)
Communication ability (affect, cognition, behavior)

Question 11

Body Structures

Answer 11

Anatomical parts of the body such as organs, limbs, head, neck, back, and trunk

Question 12

Body functions

Answer 12

Physiological functions of body systems including psychological functions

Question 13

Activity Limitations

Answer 13

Limitation in a specific activity, task, or action such as walking, lifting, standing, etc.

Question 14

Participation restrictions

Answer 14

Inability to participate in their role in society such as daily errands, work, childcare etc, to their full extent

Question 15

Clinical presentation

Answer 15

Stable and uncomplicated
Evolving with changing characteristics
Unstable characteristics with presentation

Question 16

97750

Answer 16

Physical performance test or measurment. Must be physical test (separate from eval or re-eval), requires separate written report that includes description of test, purpose of test, and outcome of test. Tinetti, TUG, Berg, DGI, FCE. TIME OR SERVICE?

Question 17

Supervised modalities

Answer 17

Service based. Does not require face to face contact after set up. Bill for both if 2 modalities are provided simultaneously.

Question 18

97010

Answer 18

Hot or cold packs. Service based.

Question 19

97012

Answer 19

Mechanical traction. Service based.

Question 20

97014

Answer 20

Unattended electric stimulation. Service based.

Question 21

97032

Answer 21

Manual electrical stimulation. Time based.

Question 22

97033

Answer 22

Iontophoresis. Time based.

Question 23

97035

Answer 23

Ultrasound. Time based.

Question 24

97110

Answer 24

Therapeutic exercises to develop strength and endurance, range of motion and flexibility. Time based.

Question 25

97112

Answer 25

Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and or proprioception for sitting/standing activities. Time based.

Question 26

97113

Answer 26

Aquatic therapy with therapeutic exercise. With clinical reason for water and progression to out of water exercise. Frequently scrutinized. Time based.

Question 27

97124

Answer 27

Massage including effleurage, petrissage, and or tapotement (stroking, compression, percussion). Time based

Question 28

97140

Answer 28

Manual therapy. Mobilization/manipulation, manual lymphatic drainage, manual traction. Included nerve glides, METs, myofscial release/stm. Should include consent for intervention, technique, tissue/joint, expected outcome.Time based.

Question 29

97530

Answer 29

Therapeutic activities: use of dynamic activities to improve functional performance. Time based. Includes lead up activities. Focus on activity not exercise.

Question 30

97535

Answer 30

Self care/home management training. ADL and compensatory training, meal prep, safety procedures, and instructions in use of assistive technology. Time based. Fall prevention/recovery training, body mechanics during household activities.

Question 31

97116

Answer 31

Gait training including stair climbing. Gait deviations or limitations being addressed. Specific techniques performed. Cuing provided. Amount of assistance. Objective measurement of balance or distance.

Question 32

97545

Answer 32

Work hardening/conditioning initial 2 hours. 97546 each additional hour. Not covered by medicare.

Question 33

97150

Answer 33

Therapeutic procedure group. Not time based.

Question 34

95992

Answer 34

Canalith Repositioning Procedures. Service based.

Question 35

Leftover time 8 minute rule

Answer 35

Add remaining time to greatest remaining time unit?