Coding/Billing Flashcards
Why is documentation important?
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
What is an ICD-9 Code?
Gives the diagnosis a name
American Hospital Association maintains the diagnosis coding guidelines
Code all documented conditions that coexist at time of service
CPT Codes
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
CPT Sections (PM & R)
Evaluation, modalities, therapeutic procedures, active wound management, tests/measures, orthotic/ prosthetic management, other
Supervised Modalities
Mechanical traction, e-stim unattended, whirlpool
Can only be billed once a day, regardless of number of body parts. Does not require direct contact
Constant Attendance Modalities
E-stim attended, iontophoresis, ultrasound
Requires direct 1:1 contact
Timed codes
8 Minute Rule Time Intervals
1 unit: 8-22 min
2 units: 23-37 min
3 units: 38-52 min
4 units: 52-67 min
Define reassessment
A daily procedure by which you use your clinical judgement about continuation of care, referral, etc. Not billable
Define re-evaluation
Periodically indicated based on changes, modifying goals, planned discharge, etc
Billable, not timed
Provides additional objective information not included in other documentation
What is an RVS Update Committee (RUC)
AMA group that can include PTs to develop a consensus opinion
What is a Resource-Based Relative Value Scale (RVS or RBRVS)
A system that decides how things need to be paid (hot pack is less than therex)
What is a Relative Value Unit (RVS)?
How much a provider gets paid for a particular CPT Code. A value is placed on a CPT code, determined by 3 factors
What are the 3 factors that determine the RVU
Work RVU
Practice Expense RVU
Malpractice Cost RVU
What is Work RVU
Provider time and intensity
Compared to current other valued codes
Value suggestion from stakeholders surveyed/consensus reached
What is Practice Expense RVU?
Clincal labor, supplies, overhead
Survey and consensus
What is Malpractice Cost RVU?
Cost of liability insurance
Small for PTs compared to other professions like surgeons
Conversion Factor
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
Geographic Practice Cost Indicator (GPCI)
Account for geographic differences in cost of practice across the county.
CMS calculates an individual GPCI for each RVU component (work, malpractice, practice expense)
Medicare Allowable Payment
Total RVU x Conversion Factor
Healthcare Common Procedure Coding System (HCPCS)
For reporting supplies, orthotic and prosthetic devices, durable medical equipment
What are the four categories related to G codes?
Mobility: walking and moving around
Changing and maintaining body position
Carrying, moving, and handling objects
Self care
G codes
Step 1: determine category
Step 2: Submit G code for primary limitation (eval, every 10th visit/reeval, 30 day separate re-eval, D/C)
Severity Modifiers
Perform a functional measure and use clinical judgement to determine level of disability using CH-CN codes
Physician Quality Reporting System (PQRS)
Quality encouragement system
Voluntary, but will be penalized in the future if provider does not participate
