Billing and Documentation

Your documentation emphasizes your need and value for _____ ______

skilled services

Your billing is important for payment and ________ rates

reimbursement

T/F: Evaluation codes are untimed

TRUE

T/F: Evaluation codes include low, moderate, and high complexity

TRUE

Low complexity eval codes include:

• Occupational profile

• Medical hx

• Brief history with chart review relating to current problem

Moderate complexity eval codes include:

• Occupational profile and medical hx

• Expanded review with chart review related to current problem. Reviewing physical, cognitive, or psychosocial history as it relates the current functional performance

High complexity eval codes include:

• Occupational profile and medical hx

• Extensive additional review of physical, cognitive, or psychosocial hx as it relates to current functional performance

Treatment codes are ______

timed

Therapeutic activities are activities to improve _____ ________

functional performance

Standing and doing a peg board is considered a _______ _________

therapeutic activity

What are some common treatment codes?

• Self care/home management

• Therapeutic activities

• Therapeutic exercises

• Neuromuscular re-education

• Cognition

  • First 15 minutes is a different code

Examples of therapeutic exercise

• ROM

• Strength

• Endurance

• Flexibility

What can be included in self-care/home management training?

• ADLs

• Compensatory training

• Meal prep

• Safety procedures

• Assistive technology device or AD training

Neuromuscular reeducation involves:

• balance

• coordination

• kinesthetic sense

• posture

• proprioception (standing or sitting)

What can fall under cognition?

• Attention

• memory

• reasoning

• executive functioning

• problem solving

• pragmatic functioning

• compensatory strategies to complete daily tasks (sequencing dressing routine)

What code would you bill for functional household furniture transfers?

Home management training

What code would you bill for scapular stabilization?

Therapeutic exercise

What code would you bill for placing days of the week and months of the year in order?

Cognition

What code would you bill for medication management?

Self care/IADLs

What code would you bill for placing cones into an overhead cabinet?

Therapeutic exercise, therapeutic activity, IT DEPENDS

The 8 minute rule was created by _____

CMS (centers for medicare and medicaid services)

At least ___ minutes of services must be done in order to count as a unit

8

The next unit is not billable until you have a full 15 minutes for the first unit at least ____ minutes past the 15-minute mark

8

If an OT practitioner consistently bills at lower ranges to capture higher units, that practitioner could be _____

audited

Some private insurance payers use the _______

Midpoint Rule or the AMA rule of 8’s

What is the AMA rule of 8’s?

A unit is assigned as long as there are at least 8 minutes for that service

• This means you could potentially bill 2 units for a 16-minute session if two different services are provided in that timeframe and both services are at least 8 minutes each

Can you bill an OT eval and treatment at the same time?

IT DEPENDS on the setting, insurance, and referral/order (eval only vs eval and tx)

How many units are you billing for for 27 minutes?

2

How many units are you billing for for 68 minutes?

5

How many units are you billing for for 48 minutes?

3

How many units are you billing for for 55 minutes?

4

How many units are you billing for for 9 minutes?

1

How many units are you billing for for 105 minutes?

7

Your pt completed toileting for 7 minutes of the session and 35 minutes of alternating between standing and sitting to assemble large puzzle. Can you bill 1 ADL/self care charge and 2 therapeutic activities?

YES- it is one session

Your pt completed 19 minutes of meal preparation/home management tasks and 18 minutes of therapeutic exercises for improved ROM/strengthening of LUE. What can you bill?

1 home management and 1 therapeutic exercise 

Independent

can complete without physical assistance or cues

Modified independent

can complete with use of AE, AD, and/or increased time

Set-up

can complete task with set up of needed items (clothing, grooming supplies, etc.) 

Supervision

No physical assistance provided. Needed for safety and cueing

Minimal assistance

Pt requires 25% physical or verbal assist of one person to complete task safely. Pt is completing 75% or more of task

Moderate assistance

Pt requires 50% physical or verbal assist of one person to complete task safely. Pt is completing 50-74% of the task

Maximal assistance

Pt requires physical or verbal assistance for 51-75% of an activity by one person. Pt is completing 25-49% of task

Total assistance

Pt requires more than 75% of physical or verbal assistance. Pt does less than 25% of task 

Types of documentation

• Evaluations

• Daily notes

• Progress notes

  • dependent upon setting, insurance, etc.

• Discharges

• Re-evaluations