Presentation on theme: "Reimbursement Seminar for Motion Analysis Laboratories"— Presentation transcript:
1 Reimbursement Seminar for Motion Analysis Laboratories Wayne Stuberg, PhD, PTGCMAS Reimbursement Committee
2 ObjectivesDescribe the differences between coding and reimbursement rules.Review the Medicare Resource-Based Relative Value Scale system related to Motion Lab coding and reimbursement.Describe the current Motion Lab Codes and their reimbursement value.Discuss the impact of Center for Medicare & Medicaid Services (CMS) Local Medical Review Policies (LMRP) on reimbursement .
3 Coding vs Reimbursement CPT codes established and published by the AMA CPT Editorial PanelInput given by professional societiesMotion Analysis CodesReimbursementPayor fee schedules often developed from CMS RBRVS physician fee schedulePayor determines:Medical necessity (ICD-9 allowable codes)LMRP written by the payor
4 Motion Analysis Codes Code Description CPT, 2002 96000 Comprehensive computer-based motion analysis by video-taping and 3-D kinematics96001dynamic pressure measurement during walking96002Dynamic surface EMG, during walking or other functional activity, 1-12 muscles96003Dynamic fine wire EMG, during walking or other functional activity, 1 muscle96004Physician review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface EMG, dynamic fine wire EMG during walking or other functional activities with written reportCPT, 2002
5 Description of CodesCodes describe services performed as part of a major therapeutic or diagnostic decision making process. Motion analysis is performed in a dedicated motion analysis lab (i.e.. facility capable of performing videotaping from the front, back and both sides, computerized 3-D kinematics, 3-D kinetics, and dynamic EMG).CPT, 2002
6 Reimbursement and RBRVS (Resource-Based Relative Value Scale) CPT Code – description of the serviceRelative Value Unit (RVU)value assigned to serviceGeographic Practice Cost Index (GPCI)cost of living adjustment by geographic areaConversion FactorCMS reimbursement per RVU ($36.79 in 2003)Service SettingCMS facility vs non-facility (Motion lab CPT codes are same for facility & non-facility)
7 Relative Value Unit (RVU) Total RVU includes 3 components:Work ExpensePractice ExpenseMalpractice ExpenseExample for CPT Code 96000Work = 1.8Practice = 0.72Malpractice = 0.02Total = 2.54
9 Motion Analysis RVUs CPT Code Description RVU CMS Fee Facility Totals 96000Motion Analysis with 3-D Kinematics2.54$93.46$150$243.4696001dynamic pressure analysis of walking3.03$111.47$261.4796002Surface EMG1-12 muscles0.59$21.07$171.0796003Fine-wire EMG1 muscle0.55$20.23$170.2396004Physician review and interp with report2.60$95.65$95.66
10 Facility vs Non-Facility Reimbursement Facility = CMS approved facilityHospitalComprehensive OP Rehab. Facility (CORF)OP Rehab. Facility (ORF)Facility allowed to bill APC (ambulatory payment classification) fee= APC 0708 (New Technology Level III) = $15096004 does not include APC fee as it is a professional service
11 LMRP & ICD-9 CodesCMS’s New York regional office has developed a local medical review policy for Motion Analysis Codes.Lists ICD-9 codes that support medical necessity, e.g. CP, spina bifida codes.States that any codes not listed as supporting medical necessity will be denied payment.
12 Case Scenario 1Child with spina bifida seen for assessment in Lab including videotaping, 3-D kinematics & kinetics, surface EMG (8 muscles), fine wire EMG (2 muscles) & physician review & interp. with written report:CPT Codes:96000, 96002, (X2) & 96004
13 Case Scenario 2Child with CP seen for assessment in Lab including videotaping & 3-D computer-based kinematics, dynamic plantar pressure measures during walking, surface EMG (8 muscles), & physician review & interp. with written report:CPT Codes:96001, 96002, & 96004
14 Common QuestionsShould I bill code X2 if we do barefoot & walking with orthoses?No, code is inclusive for the session regardless of number of conditionsShould I bill code with Motion Lab codes if PT performs physical exam with gait study?No, both are diagnostic codes & would be considered redundant
15 Common Questions Should I bill code 96000 & 96001 in the same session? No, is an extension of code 96000Should I bill code if a physical therapist reviews and interprets the gait study?No, code can only be used for physician review & interpretation
16 Common QuestionsShould a Lab bill codes if a physician is not involved in the gait study?Yes, – are Medicine CPT codes to be used for gait studies.Likelihood a Lab will be reimbursed for billing motion analysis codes for diagnoses not identified as a medical necessity?Good Question! let me know (;-)
17 The Future & Reimbursement Input to local providers regarding LMRP and Motion Analysis codes.Input to CMS regarding RVU valuations of the codes as set in 2003.Input to Advisory Panel on Ambulatory Payment Classifications (APC) to justify increasing level of APC coding.Other ideas?
18 References(regional CMS office listing)CPT 2002, AMA, 2002CPT Coding for the Gait Lab, seminar notes, GCMAS, Nov. 2002