How To Avoid Physical Therapy Denials?

Here are the following top 6 tips to assist you ignore the common physical therapy denials. These beneficial tips will ensure accurate coding to ignore the payer scrutiny, and make certain that your practice sustains to be on track towards suitable reimbursement.

  1. Compile all the Complexity of Therapy Evaluations

In accordance with the new CPT codes, which were declared in January 2017, mention three levels of complexity; low, moderate and high. It is crucial that therapists comprehend and document the particular elements that support these levels.

The compilation of CPT Manual serves as a great resource. The included descriptions for these new codes involve all the significant relevant documentation components that should be taken into analysis when documenting. Consider the codes 97161-97163 for PT evaluations and codes 97165-97167 for OT evaluations for extra information.

With the coding, the therapists must be selective and precise to ignore physical therapy denials.

The following queries must be considered when documenting PT and OT evaluation complexity:

  • On what criteria is the complexity of the evaluation depended?
  • Did an examination appear? Did it involve standardized tests or measurements? These are actually the necessary points of these codes; going beyond subjective information and involving measurable information about the pain and functional limitations of patient.
  • Does the evaluation involve an obvious plan of care with particular goals, frequency, and duration?
  • What are the treatment choices, and how will these treatments benefit the sufferer?
  1. Specificity in Relation to the Regions of Body

Make sure to compile the particular muscles and/or joints on which treatment is conducted. This assists to justify CPT codes that might need therapy on several areas of the body, and assists payers to comprehend particular wounds.

  1. Precision with Units of Time

First and foremost thing to verify is whether the payer needs all time-based services to be lumped together like with the Medicare Rule or if each time-based code requires being listed individually like with the commercial or AMA Rule. You are going to have issues getting paid rightly for your services without recognizing what the payer hopes.

According to the CPT Manual, a unit of time is gained when the provider reaches the midpoint. For PT and OT codes, the midpoint is 8 minutes or half of 15 minutes. This is usually termed as the eight-minute rule.

  1. Correct Time to use Modifier 59

Modifier 59, which demonstrates a unique procedural service, might impose to PT/OT when the same provider conducts 2 timed processes in two distinctly different blocks of time on the similar day. In such condition, the provider can bill both services using modifier 59. Add the modifier to the code for therapeutic exercise.

Providers should not bill time-based codes for more than one sufferer at a time unless they can indicate that the services were rendered at entirely different times or if a PT or OT assistant helped with the delivery of care.

One such exception is processes conducted in a group setting. Bill code 97150 for each member of the group for such type of therapy. This isn’t a time-based code, and reimbursement is generally lower for this service.

  1. Review the Timed & Untimed Electrical Stimulation

CPT code 97032 should be billed by the therapists for attended or timed electrical stimulation and 97014 for unattended or untimed electrical stimulation. If a therapist isn’t physically present, with straight contact to the patient, they won’t be capable to bill for the attended or time-based code. Payers will refuse or down-code to the unattended or untimed CPT code. It is also a great concept to review your carrier before billing these codes.

  1. Analyze the Referral & Utilization Before Rendering Treatment carefully

Does the current diagnosis of the sufferer match the diagnosis for which PT or OT has been ordered? If it doesn’t, the specific diagnosis should be clarified before the treatment being rendered.

Ensure that the care’s plan is medically essential for the diagnosis and the findings revealed during the examination. Ignore the prolonged, unimportant treatments to generally increase revenue.

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