2 Hi! In this module, you will learn about physical medicine, acupuncture, and manipulation. Let’s first take a look a Physical Medicine…OverviewPart I: Physical MedicinePhysical Medicine GuidelinesPatient EvaluationPart I: Physical MedicinePhysical Medicine GuidelinesPatient EvaluationAcupunctureManipulation
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 fromLet’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:LightHeat & ColdWaterElectricityMechanical ApparatusMassageAssessment & EvaluationWork Hardening
5 Occupational Therapists Patient EvaluationJust 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 TherapistsOccupational TherapistsAthletic TrainersPhysical MedicineEvaluation CodesPhysiciansE & M codesAdditionally, 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 ServicesWork HardeningAcupunctureOsteopathic ManipulationChiropractic Manipulation
7 ...related to the performance of work tasks. Work HardeningWork 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:StrengthEnduranceMovementFlexibilityMotor controlCardiopulmonary capacity...related to the performance of work tasks.
8 Work HardeningWork hardening programs may include services from several specialties.Work hardening programs may include a:Rehabilitation specialistTreating physicianPsychologistVocational 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 HardeningMany 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 minutesCPT 97811: without electrical stimulation – each additional 15 minutesCPT 97813: with electrical stimulation - initial 15 minutesCPT 97814: with electrical stimulation – each additional 15 minutesAcupuncture codes = 15 minute increments
13 Time = Face to face time, not the time needles are in place. AcupunctureThere 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 orOffice 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 ManipulationOsteopathic ManipulationChiropractic 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 RegionUpper ExtremitiesCervical RegionRib CageThoracic RegionAbdomen & Visceral RegionPelvic RegionLumbar RegionLower ExtremitiesSacral 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 Regionincludes atlanto-occipital jointNow let’s take a look at CPTThoracic Regionincludes costovertebral andcostotransverse jointsLumbar RegionPelvic RegionSacral Region*Only the most extensive code is allowed to pay.
20 Chiropractic Manipulation For CPT 98943, the following regions apply:Head Regionincludes temporomandibular jointexcludes atlanto-occipital jointRib Cageexcludes costotransverse jointAbdomenexcludes costovertebral jointUpper ExtremitiesLower 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 codeDocumentation 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.