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

2. Hi! In this module, you will learn about physical medicine, acupuncture, and manipulation. Let’s first take a look a Physical Medicine…
Overview
Part I: Physical Medicine
Physical Medicine Guidelines
Patient Evaluation
Part I: Physical Medicine
Physical Medicine Guidelines
Patient Evaluation
Acupuncture
Manipulation

3. 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
Let’s take a look…

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

5. Occupational Therapists
Patient Evaluation
Just like other types of services, physical medicine patients undergo an evaluation to assess the nature and extent of an injury.
The type of code used to bill for evaluation services depends on the type of provider.
Physical Therapists
Occupational Therapists
Athletic Trainers
Physical Medicine
Evaluation Codes
Physicians
E & M codes
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. Work hardening programs are common methods of treating work-related injuries. Let’s take a look...
Part II: Other Services
Work Hardening
Acupuncture
Osteopathic Manipulation
Chiropractic Manipulation

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

8. 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. 3. Work hardening programs typically last for more than a few hours.
There are several things you should be aware of when reviewing charges for work hardening.
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.
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.
3. Work hardening programs typically last for more than a few hours.

10. You can verify this information by reading the documentation.
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?
That’s right!
You can verify this information by reading the documentation.

11. Acupuncture services are subject to guidelines as well...
Let’s take a look…

12. Acupuncture codes include:
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. Time = Face to face time, not the time needles are in place.
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 or
Office visits are included with acupuncture unless modifier -25 is attached. Documentation must show significant, separately identifiable E/M services performed.

14. Osteopathic Manipulation
Lastly, we will discuss osteopathic and chiropractic manipulation services...
Osteopathic Manipulation
Osteopathic Manipulation
Chiropractic Manipulation

15. Osteopathic Manipulation
Osteopathic manipulation focuses on correcting body mechanics and structural abnormalities to treat illness, injury, and disease.
Osteopathic manipulation codes are:
Limited to Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs).
Osteopathic Manipulation codes range from –
Osteopathic manipulation procedure codes depend on how many body regions are manipulated.
Let’s take a look…

16. Osteopathic Manipulation
Body regions include:
Head Region
Upper Extremities
Cervical Region
Rib Cage
Thoracic Region
Abdomen & Visceral Region
Pelvic Region
Lumbar Region
Lower Extremities
Sacral Region

17. Chiropractic Manipulation
In addition to osteopathic manipulation, there are chiropractic manipulation procedures.
Let’s take a look…

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

19. Chiropractic Manipulation
For CPT through CPT 98942, regions include: 
Cervical Region
includes atlanto-occipital joint
Now let’s take a look at CPT
Thoracic Region
includes costovertebral and
costotransverse joints
Lumbar Region
Pelvic Region
Sacral Region
*Only the most extensive code is allowed to pay.

20. Chiropractic Manipulation
For CPT 98943, the following regions apply:
Head Region
includes temporomandibular joint
excludes atlanto-occipital joint
Rib Cage
excludes costotransverse joint
Abdomen
excludes costovertebral joint
Upper Extremities
Lower Extremities

21. 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.
Yes!
Manipulation codes are keyed as billed

22. Summary Physical Medicine: General Guidelines
How work hardening and acupuncture services are reimbursed.
Osteopathic and chiropractic services.