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Provided by Coventry Health Care Usual & Customary Medical Bill Reviewer Training Program Unit 1: Professional Services Module 8: Physical Medicine & Manipulation.

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Presentation on theme: "Provided by Coventry Health Care Usual & Customary Medical Bill Reviewer Training Program Unit 1: Professional Services Module 8: Physical Medicine & Manipulation."— Presentation transcript:

1 Provided by Coventry Health Care Usual & Customary Medical Bill Reviewer Training Program Unit 1: Professional Services Module 8: Physical Medicine & Manipulation ©2011 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission of Coventry Health Care

2 Usual and Customary Training – Physical MedicineJuly 2011 Overview Hi! In this module, you will learn about physical medicine, acupuncture, and manipulation. Lets first take a look a Physical Medicine… Part I: Physical Medicine Physical Medicine Guidelines Patient Evaluation Acupuncture Manipulation Part I: Physical Medicine Physical Medicine Guidelines Patient Evaluation

3 Usual and Customary Training – Physical MedicineJuly 2011 Physical Medicine Guidelines Physical medicine focuses on the diagnosis, treatment, and prevention of illness or injury by physical means. The physical medicine section ranges from 97001-97799. Lets take a look…

4 Usual and Customary Training – Physical MedicineJuly 2011 Physical medicine also involves services such as: Physical Medicine Guidelines Physical medicine services encompass many different types of treatment. Physical medicine includes the use of: Light Heat & Cold Water Electricity Mechanical Apparatus Massage Assessment & Evaluation Work Hardening

5 Usual and Customary Training – Physical MedicineJuly 2011 Patient Evaluation Just like other types of services, physical medicine patients undergo an evaluation to assess the nature and extent of an injury. Physical Therapists Occupational Therapists Athletic Trainers Physicians Physical Medicine Evaluation Codes E & M codes The type of code used to bill for evaluation services depends on the type of provider. Additionally, there are medicine codes for tests and measurements that can be billed. These may include things like: range of motion testing functional capacity testing muscle testing

6 Usual and Customary Training – Physical MedicineJuly 2011 Work Hardening Part II: Other Services Work Hardening Acupuncture Osteopathic Manipulation Chiropractic Manipulation Work hardening programs are common methods of treating work-related injuries. Lets take a look...

7 Usual and Customary Training – Physical MedicineJuly 2011 Work Hardening Work hardening is an individualized, goal-oriented program that assists an injured worker re-adjust to the physical demands of a job. The American Physical Therapy Association states that work hardening improves: Strength Endurance Movement...related to the performance of work tasks. Flexibility Motor control Cardiopulmonary capacity Each program typically includes conditioning exercises and simulated work activities tailored to the patient.

8 Usual and Customary Training – Physical MedicineJuly 2011 Work Hardening Work hardening programs may include services from several specialties. Work hardening programs may include a: Rehabilitation specialist Treating physician Psychologist Vocational rehabilitation specialist

9 Usual and Customary Training – Physical MedicineJuly 2011 Work Hardening There are several things you should be aware of when reviewing charges for work hardening. 2. Work hardening is reimbursed according to time increments. All services performed within a specific length of time are included in the charge, and should not be reimbursed separately. 1. Physical therapy provided in combination with the work hardening program, such as a warm-up or cool-down, is considered part of the program and is not separately reimbursable. 3. Work hardening programs typically last for more than a few hours.

10 Usual and Customary Training – Physical MedicineJuly 2011 Work Hardening Many physical therapy groups bill for work hardening when performing a lot of varied procedures and modalities, not an actual program. How might you identify whether physical therapy charges were for work hardening program? Thats right! You can verify this information by reading the documentation.

11 Usual and Customary Training – Physical MedicineJuly 2011 Acupuncture Lets take a look… Acupuncture services are subject to guidelines as well...

12 Usual and Customary Training – Physical MedicineJuly 2011 Acupuncture Acupuncture involves the stimulation of specific points on or near the surface of the body in order to treat a patient for pain, as well as diseases and disorders of the body. Acupuncture codes include: CPT 97810: without electrical stimulation – initial 15 minutes CPT 97811: without electrical stimulation – each additional 15 minutes CPT 97813: with electrical stimulation - initial 15 minutes CPT 97814: with electrical stimulation – each additional 15 minutes Acupuncture codes = 15 minute increments

13 Usual and Customary Training – Physical MedicineJuly 2011 Acupuncture There are a few guidelines that you should be familiar with when reviewing charges for acupuncture services: Time = Face to face time, not the time needles are in place. Only 1 initial code may be billed per visit. All additional time coded with 97811 or 97814. Office visits are included with acupuncture unless modifier -25 is attached. Documentation must show significant, separately identifiable E/M services performed.

14 Usual and Customary Training – Physical MedicineJuly 2011 Osteopathic Manipulation Chiropractic Manipulation Lastly, we will discuss osteopathic and chiropractic manipulation services...

15 Usual and Customary Training – Physical MedicineJuly 2011 Osteopathic Manipulation Osteopathic manipulation focuses on correcting body mechanics and structural abnormalities to treat illness, injury, and disease. Osteopathic Manipulation codes range from 98925 – 98929. Osteopathic manipulation codes are: Limited to Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs). Osteopathic manipulation procedure codes depend on how many body regions are manipulated. Lets take a look…

16 Usual and Customary Training – Physical MedicineJuly 2011 Osteopathic Manipulation Body regions include: Cervical Region Thoracic Region Lumbar Region Sacral Region Head Region Rib Cage Lower Extremities Upper Extremities Abdomen & Visceral Region Pelvic Region

17 Usual and Customary Training – Physical MedicineJuly 2011 Chiropractic Manipulation Lets take a look… In addition to osteopathic manipulation, there are chiropractic manipulation procedures.

18 Usual and Customary Training – Physical MedicineJuly 2011 Chiropractic Manipulation Chiropractic manipulation focuses on the improvement of joint and neuro-physiological function. Chiropractic Manipulation codes range from 98940 – 98943. Chiropractic manipulation codes not only depend on the number of body regions manipulated, but which body region as well.

19 Usual and Customary Training – Physical MedicineJuly 2011 Chiropractic Manipulation For CPT 98940 through CPT 98942, regions include: Cervical Region Thoracic Region Lumbar Region Sacral Region includes atlanto-occipital joint includes costovertebral and costotransverse joints Pelvic Region Now lets take a look at CPT 98943... *Only the most extensive code is allowed to pay.

20 Usual and Customary Training – Physical MedicineJuly 2011 Chiropractic Manipulation Head Region Rib Cage Lower Extremities Upper Extremities Abdomen For CPT 98943, the following regions apply: includes temporomandibular joint excludes atlanto-occipital joint excludes costotransverse joint excludes costovertebral joint

21 Usual and Customary Training – Physical MedicineJuly 2011 Office Visits with Manipulation If osteopathic or chiropractic manipulation is billed, can E/M also be billed? Modifier -25 must be attached to the office visit code Documentation must show significant separately identifiable E/M services were rendered. Manipulation codes are keyed as billed Yes!

22 Usual and Customary Training – Physical MedicineJuly 2011 Summary How work hardening and acupuncture services are reimbursed. Physical Medicine: General Guidelines Osteopathic and chiropractic services.


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