Week 7: Billing and Coding Flashcards
What is the Service Payment Cycle?
What are ICD codes and how are they categorized?
○ Medical Dx
■ Broad code categories: Body systems, condition types
■ Start with a letter and followed by numbers
○ Treatment Dx
■ Performance deficit impacting the client’s ability to perform desired occupations
What are CPT codes?
○ For all rehab providers (OT, PT, and SLP)
○ Commonly used coded for OT (AOTA)
○ Coding: Treatment Procedure (CPT) Procedures
■ Modalities
■ Therapeutic Procedures
■ Active Wound Care mgmt.
■ Orthotic/prosthetic mgmt.
■ Neurology and Neuromuscular Procedures
■ Cognitive functioning
■ Health and Behavior Assessment/Intervention
■ Adaptive Behavior Treatment
What is the significance of documentation?
The official written record that gives information about the provision of OT services.
○ Centers for Medicare and Medicaid Services (CMS): Skilled services, medical necessity, and
reasonable and necessary
○ Subject to interpretation by a medical reviewer
What is the “8 minute” rule and how do you apply it?
○ Must see a patient for at least 8 min to bill for 1 unit
○ “8 minute” is when the occupational therapist must see the client for a minimum of 8 minutes
to bill for the appointment. Therefore, if the appointment is 15 minutes, but the client is 8
minutes late, the therapist canNOT see the patient because it is under the “8 minute” rule (7
min appt) and cannot bill 1 unit for the scheduled 15 min appointment.
Example:
You spent 35 minutes with your client, and you use the CPT code 97535
● 97535: Self-care/home management training (e.g., activities of daily living [ADLs] and compensatory
training, meal preparation, safety procedures, and instructions in use of assistive technology
devices/adaptive equipment), direct one- on-one contact, each 15 minutes.
○ 1 unit = 8-22 minutes
○ 2 units = 23-37 minutes
● Therefore, you should bill for for 2 units (spent 35 minutes)
