Unit 2-WK6- Diagnosis and Procedural Coding I and II Flashcards
Why is it important for physical therapists to understand how to select the correct codes ?
To demonstrate medical necessity for PT
PTs are also held accountable for their coding; they can be held liable for incorrect billing.
ICD-10 ccodes are used to describe Medical and Physical Therapy Treatment diagnoses what is the difference ?
Medical Diagnosis: femur fracture, CVA
medical reason they’re seeing a PT
Physical Therapy/Treatment diagnosis: labeling of PT diagnosis for which the patient will be treated. knee pain muscle stiffness etc.
List the benefits of ICD-10 codes.
laterality ( RT v LT)
traumatic or non-traumatic injury
dominant side or non-dominant side
unilateral or b/l
cause of traumatic injury
place of occurrence
activity being performed when illness/injury occurred
Describe the anatomy of an ICD-10 code.
Category: the first 3 characters of a code, signifies diagnosis that relates to a chapter, normally used in conjunction with number to specify injury
Etiology, Anatomic site, severity: spaces 3-6, the cause anatomic site, severity, or other vital clinical details
Extension: the 7th character: episode of care
S86.011D
How do you determine the first ICD-10 CM code on your eval ?
The first code is the main reason that the patient is receiving therapy, other codes are then detailed for other conditions the patient may have
code can describe symptoms if MD has not diagnosed.
Explain the different 7th characters.
A(initial): used for the entire period in which a patient receiving active treatment for the condition
D( subsequent): after the active phase of treatment when the patient is receiving routine care for the condition during ht period of healing or recovery phase of treatment.
S( sequela): complications or conditions that arises as a direct result of the condition
What chapter is the 7th character REQUIRED for ?
CH19+15
Do all codes have 7th characters ?
no
What is the purpose of external clause codes ?
they capture how conditions occured, provide context, function as secondary codes
What are the different kinds of external cause codes ?
external cause code, place of occurence, activity, intent, individuals status
Is it mandatory to report external cause codes ?
no
Do external cause codes apply to all categories of diagnosis codes ?
no
Where do you document external cause codes ?
on initial evaluation; not principle diagnosis
When should “ aftercare codes” be used ?
first try to find the 7th character code
if there is no other way to express that patient is on the after side of an aforementioned before and after event.
code for underlying conditions
For conditions involving multiple sites such as OA, there often is a “ multiple sites” code available. If none is available you should:
list multiple codes to indicate all different sites involved.
Acute vs Chronic or reccurent codes are found in what chapters ?
19 includes: acute, traumatic problems
13: includes chronic or recurrent problems.
What is the difference between ICD-10 codes and CPT codes ?
CPT= procedure codes, interventions
ICD-10= diagnosis codes
When are CPT codes updated by the AMA ?
every jan 1st
In outpatient settings CPT codes are used for __________ while in inpatient settings they are used for ____________
billing
productivity, staffing, tracking
CPT codes have different values based on:
work expenses
practice expenses
geographical location
Compare and contrast service based and time based CPT codes
service based: untimed
bill on unit of code per discipline, per practice, per insurance
does not matter how many different body parts you treat or how long you treat.
Time based: 1 on 1 patient contact
timed in 15 minute increments= 1 unit
can bill multiple units of the same time based CPT code on same day per discipline per patient.
What series are the majority of CPT codes forr PT procedures found ?
97000 series
Describe what can happen if a PT bills for procedures they did not provide.
audits, fines, litigation, loss of license
Compare and contrast supervised modalities vs constant attendance modalities.
supervised- modality that does not require 1 on 1 patient contact ( untimed and service based )
constant attendance- modality that requiress direct 1 on1 patient contact ( time based, minute units)
Explain what therapeutic procedures are and how the interventions for it are used.
- direct patient contact; 1 on 1
- requires the PT to maintain direct patient contact during the provision of services
What does Therapeutic exercise include ?
strength
ROM
flexibility
endurance
functional limitations
List examples of documenting skill forr therapeutic exercise.
” PROM flexion and extension to LT knee to prevent joint contracture, 10x10 reps in each direction, monitoring for pain w/ each repetition’
Neuromuscular reducation is used when you are providing services to improve:
balance, coordination, kinesthesia, proprioception
Gait training is defined as:
direct 1 on 1 contact in performance of directive exercises or activities designed to improve a patient’s ability to ambulate safely and efficiently
ambulation on level and unlevel surfaces
stair training
education of use of an assistive device
ambulating w/ prosthesis or orthosis
ambulation to decrease gait deviations
educating a caregiver on how to guard a patient during ambulation
Therapeutic activities is defined as:
use of functional/dynamic activities to improve/restore functional performance in a progressive manner.
such as:
bed mobility
transfer training
car transfer
lifting and carrying
pushing and pulling
pinching and grasping
crawling and climbing
throwing and jumping
any functional activities
Manual therapy techniques is used to:
decrease pain, swelling, and increase joint mobility and ROM
such as:
joint mobs
manipulation
manual lymphatic drainage
manual traction
myofascial release
Self/care home management training is used for anything that involves:
anything that involves training the patient how to function in their home
such as:
ADLs
meal prep
safety procedures
personal hygiene
chores and cleaning
When instructing a patient in an HEP should you bill the home management code ?
No, it would go under TherEx or NMR
Aquatic therapy can be billed:
any activity performed in the water
What must be included in the documentation when billing for aquatic therapy ?
why it is reasonable and necessary
i.e. why patient cannot tolerate land therapy
Community worrk integration training is the codes used anytime you work toward:
re-integrating patient into community
such as:
shopping
transportation
money management
assistive tech
Wheelchair management is used for
assessment, fitting, or training for a wheel chair
would include any therapy regarding a wheel chair
Work hardening/conditioning is used to address:
specific, work related lifting, pulling, carrying, anything specific to occupational requirement
Group therapy involves constant attendance but does not require one on one patient contact. The therapist is working with ____________ while providing skilled therapy.
2 or more patients
Is group therapy timed or untimed code ?
untimed
LT shoulder PROM into flexion, extension, adduction, and abduction, 3x10 in each direction would be coded as :
Therapeutic Exercise
Standing on a wobble board without UE support, focus on ankle reactions and maintaining balance would be coded as:
NME
TENS to low back, x15 minutes while therapist documents at desk would be coded as
unattended e-stim
transferring in< > out of a car using a walker with CGA and cues for correct sequencing would be coded as
therapeutic activites
ambulating in the hallway with a quad can x8 minutes to improve activity tolerance would be coded as
therapeutic exercise
sidesteping right and left over small hurdles with 3 lbs ankle weights with focus on increasing hip flexion to clear the hurdle would be coded as
TherEx
Sidestepping to right and left over small hurdles with 3 lbs ankle weights with focus on ankle reactions and increasing single leg stance would be coded as
NME
PT eval codes reflect the _____, ______ and __________ of PTs in caring their patients/clients.
expertise, skill, and responsibility
Are PT evals and re-evals codes timed or untimed ?
untimed
The PT eval codes reflect 3 levels of patient presentation:
low
moderate
complex
The components used to determine which eval code to use:
patient Hx
examination
clinical presentation
Explain the low moderate and high categories for patient Hx
low: no personal factors or comorbidities
moderate: 1-2 personal factors or comorbidities
high: 3+ personal factors or comorbidities
Explain the low moderate and high categories for the examination of eval codes.
low: 1-2 areas assessed
moderate: 3+ areas assessed
high: 4+ areas assessed
Explain the clinical presentation low moderate and high categories:
low: no complicating factors
moderate: evolving condition
high: unstable condition
Should time be used when determining eval codes ?
no
Describe how you determine which eval code to bill for after completing a patient evalutation.
low to high in each category then choose the lowest one
Describe the re-evaluation of an established POC CPT code.
an exam that includes a Hx review and use of standardized test and measures
a revised POC using a standardized patient assessment instrument.
When is it appropriate to bill for a re-evaluation ?
a. improvement or decline, or change in pts condition not anticipated
b. new clinical findings during Tx
c. the patient fails to respond to Tx in POC
d. if state practice act requires it
e. treating a chronic condition
