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)