Week 2 Billing and Documentation IAR

Your documentation emphasizes your _________ and value for _________ services

Need, skilled

Billing is important for…

Reimbursement, payment

What codes are not based on a time component but instead complexity?

Evaluation codes

What does a low complexity evaluation code encompass?

Occupational profile and medical history. Brief history with chart review relating to current problem

What does a moderate complexity evaluation encompass?

Occupational profile and medical history. Expanded review with chart review related to current problem; reviewing physical, cognitive, or psychosocial history as it relates to current functional performance

What does a high complexity evaluation encompass?

Occupational profile and medical history. Extensive additional review of physical, cognitive or synchro social history as it relates to current functional performance

What is the 97535 code for?

Self care/home management

What s the 97530 code for?

Therapeutic activities

What is the 97110 code for?

Therapeutic exercise

What is the 97112 code for?

Neuromuscular re-education

What is the 97129 and 97130 codes for?

Cognition

What are the categories of common treatment codes that you will use in OT?

Self care/home management

Therapeutic activities

Therapeutic exercises

Neuromuscular re-education

Cognition

What intervention activities fall under the self-care/home management category?

ADLs

Compensatory training

Meal prep

Safety procedures

Assistive technology device or AD training

How are activities that fall under the therapeutic activities category defined?

Activities to improve functional performance

What kind of activities fall under the therapeutic exercise category?

ROM

Strength

Endurance

Flexibility

What kind of activities fall under the neuromuscular re-education category?

Balance

Coordination

Kinesthetic sense

Posture

Proprioception (standing and sitting)

What kind of activities/focuses fall under the cognition category?

Attention

Memory

Reasoning

Executive functioning

Problem solving

Pragmatic functioning

Compensatory strategies to complete daily tasks

Who created the 8 minute rule?

Centers for Medicare and Medicaid Services (CMS)

What is the 8-minute rule?

At least 8 minutes of services must be done in order to count as a unit; the next unit is not billable until you have full 15 minutes following the 8 minute mark

If you consistently bill at lower ranges to get more units, you may be…

Audited

1 unit

8-22 minutes

2 units

23-37

3 units

38-52 minutes

4 units

53-67 minutes

5 units

68-82 minutes

6 units

83-97 minutes

7 units

98-112 minutes

8 units

113-127 minutes

If you see a client for 7 minutes, how many units do you charge for?

None

If you treat and individual for 36 minutes, addressing self-care/home maintenance for one half of the session and therapeutic exercise for the other half, how many units do you bill them for?

1 for self-care and 1 for therapeutic exercise

Of you see a patient for 40 minutes and address ADLs for 7 minutes and Therpeutic activities for 33 minutes, how many units do you bill for?

1 for ADLs and 2 for therapeutic activities

What is the AMA rule of 8’s or the midpoint rule?

It’s a rule used by some private insurance payers; each services is assigned units separately but they HAVE to be 8 minutes

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

You can but it depends upon the setting, insurance, and/or referral (if it states eval and treat)

Level of assistance: independent

Can complete without physical assistance or cues

Level of assistance: modified independent

Can complete with use of AE, AD, and/or increase time

Level of assistance: set-up

Can complete task with set up of needed items (ex: laying their clothes out for them during a dressing activity)

Level of assistance: supervision

No physical assistance provided. Needed for safety, cueing

Level of assistance: minimal assistance

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

Level of assistance: moderate assistance

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

Level of assistance: maximal assistance

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

Level of assistance: total assistance/dependent

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

What are the different types of documentation?

Evaluations

Daily notes

Progress notes

Discharges

Re-evaluations