Reimbursement Update Corner

Cardiopulmonary Physical Therapy Journal, Mar 2004

Welcome to a new feature of the Cardiovascular and Pulmonary Journal, provided by the Legislative Committee. The committee welcomes any new information, input or questions, and answers. Send to the Legislative Chair, Ellen Hillegass: ezhillegass@mindspring.com

Latest from Washington:

On December 8, 2003 the President signed the Medicare Prescription Drug and Improvement Act into law. The new law blocks enforcement of the $1,590 Medicare therapy cap, as well as creating a prescription drug benefit.

The 2004 conversion factor for physical therapy services will be approximately $37.34 which is up from $36.786 in 2003. APTA has updated its Medicare fee schedule calculator on their web site www.apta.org/govt_ affairs/regulatory/medicare for specific codes used by PTs.

Coding Issues:

CMS has listed its relative values associated with the new CPT code (97755) for assistive technology assessment, which is effective January 2004. The relative value total is .93.

Physical therapists often ask if any provider can bill CPT codes from the Physical Medicine and Rehabilitation series of codes. The APTA's Reimbursement News provided the response for this question as follows:

"The Physical Medicine and Rehabilitation codes, sometimes known as the "9700 series" of codes are typically used by PTs and OTs. However, CPT 2003 coding book states that "It is important to recognize that the listing of a service of procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care professional."

Therefore, any provider may bill an intervention described in the 97000 series of codes as long as their practice act permits them to perform the service. Some third-party payers do have payment policies that restrict certain providers from receiving payment for specific services in the 97000 series.

LMRP Update:

Latest revision (January 2004) in Pulmonary Rehab LMRP for United Government Services (LJGS) fiscal intermediary can be found on their web site: http://www. ugsmedicare.com/LMRP/OPSNFLMRPIndex.aspttO. If you can't get it this way just go onto www.ugsmedicare.com and look under providers, LMR Policies. UGS is the fiscal intermediary for Medicare for Wisconsin, Michigan, California, and Virginia.

Tips on Documentation:

* Every page of your documentation should include the date and time of service.

* Make sure your targeted audiences understand your abbreviations and acronyms.

* Make sure progress has been documented in a measurable, objective format, and correlated with function.

* Make sure you document any changes in the patient's condition, and revised goals to reflect those changes.

QUESTIONS AND ANSWERS

Coding Usage

Q: I have several patients who have been referred to me who are limited in walking due to leg pain and have a diagnosis of Peripheral Vascular Disease. Do I use the CPT code 93668 (peripheral arterial rehabilitation) to bill for my physical therapy evaluation and treatments?

A: No. Patients with a diagnosis of peripheral arterial or vascular disease that are referred to physical therapy should be billed as all other physical therapy patients, using the PT evaluation code and then the appropriate CPT codes for the procedures used (therapeutic exercise, gait, etc.)

* Much of the information in this update has been graciously supplied by the Physical Therapy Reimbursement News, Jan/Feb 2004, published by the APTA.