Coding/Billing

Question 1

Why is documentation important?

Answer 1

Record of patient care, status, PT management, outcome of intervention, legal/licensure situations
Tool for planning and provision of services
Communication among providers
Demonstrate compliance with federal, state, payer, local regulations

Question 2

What is an ICD-9 Code?

Answer 2

Gives the diagnosis a name
American Hospital Association maintains the diagnosis coding guidelines
Code all documented conditions that coexist at time of service

Question 3

CPT Codes

Answer 3

Names what we bill
If youre paid by the DRG or RUG system, then codes probably aren’t leaving the building since DRG and RUG are paid for by one lump sum

Question 4

CPT Sections (PM & R)

Answer 4

Evaluation, modalities, therapeutic procedures, active wound management, tests/measures, orthotic/ prosthetic management, other

Question 5

Supervised Modalities

Answer 5

Mechanical traction, e-stim unattended, whirlpool

Can only be billed once a day, regardless of number of body parts. Does not require direct contact

Question 6

Constant Attendance Modalities

Answer 6

E-stim attended, iontophoresis, ultrasound
Requires direct 1:1 contact
Timed codes

Question 7

8 Minute Rule Time Intervals

Answer 7

1 unit: 8-22 min
2 units: 23-37 min
3 units: 38-52 min
4 units: 52-67 min

Question 8

Define reassessment

Answer 8

A daily procedure by which you use your clinical judgement about continuation of care, referral, etc. Not billable

Question 9

Define re-evaluation

Answer 9

Periodically indicated based on changes, modifying goals, planned discharge, etc
Billable, not timed
Provides additional objective information not included in other documentation

Question 10

What is an RVS Update Committee (RUC)

Answer 10

AMA group that can include PTs to develop a consensus opinion

Question 11

What is a Resource-Based Relative Value Scale (RVS or RBRVS)

Answer 11

A system that decides how things need to be paid (hot pack is less than therex)

Question 12

What is a Relative Value Unit (RVS)?

Answer 12

How much a provider gets paid for a particular CPT Code. A value is placed on a CPT code, determined by 3 factors

Question 13

What are the 3 factors that determine the RVU

Answer 13

Work RVU
Practice Expense RVU
Malpractice Cost RVU

Question 14

What is Work RVU

Answer 14

Provider time and intensity
Compared to current other valued codes
Value suggestion from stakeholders surveyed/consensus reached

Question 15

What is Practice Expense RVU?

Answer 15

Clincal labor, supplies, overhead

Survey and consensus

Question 16

What is Malpractice Cost RVU?

Answer 16

Cost of liability insurance

Small for PTs compared to other professions like surgeons

Question 17

Conversion Factor

Answer 17

Number determined by CMS that converts the RVU to a dollar amount. Adjusted annually as a way of controlling expenditures. Has been decreasing, which decreases everything else

Question 18

Geographic Practice Cost Indicator (GPCI)

Answer 18

Account for geographic differences in cost of practice across the county.
CMS calculates an individual GPCI for each RVU component (work, malpractice, practice expense)

Question 19

Medicare Allowable Payment

Answer 19

Total RVU x Conversion Factor

Question 20

Healthcare Common Procedure Coding System (HCPCS)

Answer 20

For reporting supplies, orthotic and prosthetic devices, durable medical equipment

Question 21

What are the four categories related to G codes?

Answer 21

Mobility: walking and moving around
Changing and maintaining body position
Carrying, moving, and handling objects
Self care

Question 22

G codes

Answer 22

Step 1: determine category

Step 2: Submit G code for primary limitation (eval, every 10th visit/reeval, 30 day separate re-eval, D/C)

Question 23

Severity Modifiers

Answer 23

Perform a functional measure and use clinical judgement to determine level of disability using CH-CN codes

Question 24

Physician Quality Reporting System (PQRS)

Answer 24

Quality encouragement system

Voluntary, but will be penalized in the future if provider does not participate

Question 25

Original 3 purposes for participating in PQRI/PQRS

Answer 25

Opportunity to improve care of patients through the evidence based measures that are based upon clinical guidelines
Prepare for future pay for performance programs
Eligible professionals will be entitled to 1.5% monetary incentive bonus

Question 26

PT and PQRS

Answer 26

PTs eligible for 8 measures, total of 127. Must report on 3, 4 to be safe
Based on NPI Number