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S4- Acute Care > Week 1- Emergency Department PT and Acute Care Billing > Flashcards

Week 1- Emergency Department PT and Acute Care Billing Flashcards

1
Q

PART 1: EMERGENCY DEPARTMENT PT

A

PART 1: EMERGENCY DEPARTMENT PT

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2
Q

What is emergency department PT?

A

PT services performed exclusively in the emergency department of a hospital.

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3
Q

What are the (3) steps of the mentality in an ER?

A
  • Triage
  • stabilize and keep the pt alive
  • Get them out
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4
Q

Why is the ER mentality how it is?

A

Because there is a constant influx of patients, goal is to get them to somewhere else to make “room” after stabilization.

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5
Q

Does the ER have specialized areas?

A

No, they will stabilize whoever they get in whether it be a stroke, heart attack, broken leg, etc.

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6
Q

Is the ER setup for physical therapy?

A

No, set up to get patients in and out therefore rooms are small, and supplies are low.

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7
Q

Why do we use PTs in the ED? (3)

A
  • Reduce number of inpatient hospitalizations.
  • Safety evaluation and discharge planning.
  • Decreased imaging, decreased opioid use in ED, and decreased opioid prescription.
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8
Q

When patients come to a hospital, what 2 options do they have?

A
  • Stay in observation

- Admitted to hospital or given inpatient status

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9
Q

Why might someone stay in observation in the emergency room and not be admitted to the hospital?

A

-May not have qualifying medical diagnosis to be admitted to hospital.

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10
Q

Why is reducing the number of inpatient hospitalizations important?

A
  • Creates more space/beds for those that are actually sick.

- Helps with reimbursement, cheaper to stay in observation status in ER than inpatient.

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11
Q

Does location matter in with PT Interventions used?

A
  • No, no matter the location, it is still the same PT treatments!
  • May have to modify or adjust the delivery, but the basis of the treatment and foundation is the SAME.
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12
Q

What are the (4) challenges of PT in the ED?

A
  • Time
  • Fluctuating productivity/patient caseload
  • Space
  • ED length of stay (want to keep it low in ED)
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13
Q

PART 2: ACUTE CARE BILLING

A

PART 2: ACUTE CARE BILLING

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14
Q

What are the (3) criteria for billing for PT services?

A
  • Must require the skills and expertise of a PT. (no other profession can provide this type of care)
  • Must be progressive in nature.
  • Must be medically necessary. (pt would experience some kind of decline or complication without PT)
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15
Q

What are the (3) reasons why billing in acute care is important?

A

-The rehab department costs the hospital money!
(We are not the financial drivers of hospital profits)
-Reimbursement is often bundled into the payment the hospital receives
-Effectively meet and maintain productivity

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16
Q

Acute Care Billing Cheat Sheet:
PT Initial Evaluation:
-________ charge, can only occur _____ during that specific hospital stay
-Requires a complexity of ____, ________ or _____
-Time starts when you start the _________ and stops when you walk out the patient’s door

A
  • untimed, once
  • low, moderate, or high
  • chart review
17
Q

Acute Care Billing Cheat Sheet:
PT Treatment:
-_______ charge, occurs based on quantity usually in reference to the __ minute rule.
Time starts when you walk in the patient’s room and ends when you exit
Chart review is not ______ time when doing PT treats!

A
  • timed, 8 minute rule

- billable

18
Q

Acute Care Billing Cheat Sheet:
PT Re-Evaluation:
-Re-establishes ______; patient with _______ change in status (Ex: Patient intubated and placed on ventilator, PT was discontinued, then PT re-consulted once patient extubated) (Major surgery)
-Can only be billed ____ during that hospital stay
-No ________ level, as opposed to Initial Evaluation

A
  • POC, dramatic
  • once
  • complexity
19
Q

Acute Care Billing Cheat Sheet:
PT Re-Assessment:
-Updates PT _________ (Ex: Goals expiring or patient needs updated goals)
-No specific “reassessment” charge – it is billed following the treatment _________

A
  • POC

- 8 minute rule

20
Q

8 Minute Rule:

  • For ____-______ billing units only
  • _________ based, but many other insurance providers follow these guidelines.
A
  • time-based

- medicare

21
Q

List the time for the 8 minute Rule by units.

A
  • 1 unit = 8-22m
  • 2 units = 23-37m
  • 3 units = 38-52m
  • 4 units = 53-67m
  • 5 units = 68-82m
  • 6 units = 83m
22
Q

Physical Therapy Evaluation Reference Table:

  • History
    • Low=
    • Moderate=
    • High=
  • Examination of Body Systems
    • Low=
    • Moderate=
    • High=
  • Clinical Presentation
    • Low=
    • Moderate=
    • High=
A

Physical Therapy Evaluation Reference Table:

  • History
    • Low= 0 personal factors
    • Moderate= 1-2 personal factors
    • High= 3 or more personal factors
  • Examination of Body Systems
    • Low= addressing 1-2 elements
    • Moderate= addressing 3 elements
    • High= addressing 4+ elements
  • Clinical Presentation
    • Low= stable
    • Moderate= evolving
    • High= unstable
23
Q

PT Evaluation Complexity Examples (list low, mod, or high):

  1. ) 72 year old male, PMH: DM, CHF, HTN, COPD, gout. PT consulted for weakness, balance deficits, inability to perform transfer or ambulate. Currently requiring 4L nasal cannula, telemetry, Lasix, noted acute renal failure.
  2. )50 year old male, PMH: DM, morbid obesity, CHF, HTN, COPD, previous L BKA, RA, OA. Admitted with COVID-19, developed ARDS, now with tracheostomy, with acute renal failure requiring hemodialysis and pressors.
  3. ) 25 year old female admitted with L facial droop and L sided weakness, no PMH, CT of head negative for acute infarct, PT consulted for balance deficits.
A
  1. ) Moderate
  2. ) High
  3. ) Low
24
Q

Example for PT Initial Evaluation:

  • Time chart opened: 10:00AM
  • Time walked into patient’s room: 10:15AM
  • Completed initial PT evaluation and treatment
  • Time exited patient’s room: 10:50AM
  • Total time: 50 minutes (10:00-10:50)
  • Evaluation time: 15 minutes for chart review + 20 minutes in room (35 minutes total)
  • Timed treatment: 15 minutes therapeutic activity

-What can I bill for?

A
  • 1 unit PT eval

- 1 unit TA

25
Q

Example for PT Treatment:

  • Chart reviewed from 10:00-10:05AM
  • Entered patient’s room at 10:05AM
  • Exited patient’s room at 10:40
  • Total time: 35 minutes (10:05-10:40AM)
  • Timed treatment: 30 minutes (-5 minutes for patient in bathroom)

-What can I bill for?

A

-2 units total

26
Q

Example for PT Treatment:

  • Entered room at 10:00AM
  • Patient refuses, states to get out of room, you attempt to reason with them, patient rolls over in bed and says no.
  • Exit room: 10:05AM

-What can I bill for?

A
  • Nothing

- You would write a PT attempt note stating the treatment was attempted but pt refused.

S4- Acute Care (15 decks)

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