Week 1- Emergency Department PT and Acute Care Billing Flashcards
PART 1: EMERGENCY DEPARTMENT PT
PART 1: EMERGENCY DEPARTMENT PT
What is emergency department PT?
PT services performed exclusively in the emergency department of a hospital.
What are the (3) steps of the mentality in an ER?
- Triage
- stabilize and keep the pt alive
- Get them out
Why is the ER mentality how it is?
Because there is a constant influx of patients, goal is to get them to somewhere else to make “room” after stabilization.
Does the ER have specialized areas?
No, they will stabilize whoever they get in whether it be a stroke, heart attack, broken leg, etc.
Is the ER setup for physical therapy?
No, set up to get patients in and out therefore rooms are small, and supplies are low.
Why do we use PTs in the ED? (3)
- Reduce number of inpatient hospitalizations.
- Safety evaluation and discharge planning.
- Decreased imaging, decreased opioid use in ED, and decreased opioid prescription.
When patients come to a hospital, what 2 options do they have?
- Stay in observation
- Admitted to hospital or given inpatient status
Why might someone stay in observation in the emergency room and not be admitted to the hospital?
-May not have qualifying medical diagnosis to be admitted to hospital.
Why is reducing the number of inpatient hospitalizations important?
- Creates more space/beds for those that are actually sick.
- Helps with reimbursement, cheaper to stay in observation status in ER than inpatient.
Does location matter in with PT Interventions used?
- 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.
What are the (4) challenges of PT in the ED?
- Time
- Fluctuating productivity/patient caseload
- Space
- ED length of stay (want to keep it low in ED)
PART 2: ACUTE CARE BILLING
PART 2: ACUTE CARE BILLING
What are the (3) criteria for billing for PT services?
- 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)
What are the (3) reasons why billing in acute care is important?
-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
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
- untimed, once
- low, moderate, or high
- chart review
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!
- timed, 8 minute rule
- billable
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
- POC, dramatic
- once
- complexity
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 _________
- POC
- 8 minute rule
8 Minute Rule:
- For ____-______ billing units only
- _________ based, but many other insurance providers follow these guidelines.
- time-based
- medicare
List the time for the 8 minute Rule by units.
- 1 unit = 8-22m
- 2 units = 23-37m
- 3 units = 38-52m
- 4 units = 53-67m
- 5 units = 68-82m
- 6 units = 83m
Physical Therapy Evaluation Reference Table:
- History
- Low=
- Moderate=
- High=
- Examination of Body Systems
- Low=
- Moderate=
- High=
- Clinical Presentation
- Low=
- Moderate=
- High=
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
PT Evaluation Complexity Examples (list low, mod, or high):
- ) 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.
- )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.
- ) 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.
- ) Moderate
- ) High
- ) Low
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?
- 1 unit PT eval
- 1 unit TA
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?
-2 units total
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?
- Nothing
- You would write a PT attempt note stating the treatment was attempted but pt refused.
