b'Coding for Supervised CODING Update ComplianceModalities withTherapeutic ProceduresBy David Kein at the Same TimeLEGAL NUTRITIONCouncilANJC Coding & Compliance ConsultantThere is a lot of confusion when itverbal and/or manual contact) duringservices described by timed codes. comes to coding physical medicine andprovision of the service. Therefore,The total number of timed 15-minute rehabilitation procedures. Most codingcoding for these services dependsunits that can be billed by the provider mistakes are due to a misunderstandingon the therapeutic outcome, timefor each patient is constrained by the ANJC Leadership of the differences between modalities,of performance and level of contacttotal time of the skilled therapeutic therapeutic procedures and supervisionprovided to the patient. The providersNUTRITION LEGAL EASE one-on-one intervention by the requirements for both. Therefore,direct time requirement (one-on-one) isprovider. For the untimed codes, when trying to determine whether15 minutes.including supervised modalities, or not certain physical medicinegroup therapy, and the evaluation and rehabilitation procedures cancodes, documenting the session time be billed together and at the samecan help to justify the appropriateness time, providers need to first have aof the services provided.clear understanding of certain codingREHAB Council fundamentals.While therapeutic procedures require one-on-one contact by the provider Supervised modalities, CPT codesthroughout the service, supervised 97010-97028, are defined as themodalities do not. Based on the above application of a modality that doesdefinitions and requirements, both not require direct (one-on-one) patientservices can be billed at the same time, LEGAL Q&A CHIROASSISTcontact by the provider. Additionally,provided they are both necessary and supervised modalities are coded only proper reporting requirements are Executive Directors Update once per encounter, regardless ofmet (e.g. the therapeutic procedure the number of body areas treated.is provided one-on-one and time In other words, time is not a factor inrequirements are met). For example, a determining the number of units billedpatient may receive supervised electric and the provider does not have tostimulation (97014) while also receiving have direct on-on-one contact with theAccording to Medicare Transmittalactive/passive stretching exercises patient throughout the procedure.AB-01-68; Under Medicare, for any Legislative Update (97110), and in such cases, both services single CPT code, providers bill a single Now that we have an understandingcan be billed. INSURANCE Update INSURANCE Update of how supervised modalities are15-minute unit for treatment greaterTo further support this, on its website, than or equal to 8 minutes and less than coded, lets take a look at therapeutic23 minutes. If the duration of a singleTECHNIQUE Councilprocedures.The Centers for Medicare and Medicaid modality or procedure is greater thanServices has published 11 Part B Therapeutic procedures (CPTor equal to 23 minutes to less than 38Billing Scenarios for PTs and OTs that 97110-97546) are defined as: Aminutes, then 2 units should be billed addresses this very issue: manner of effecting change throughThe pattern remains the same forIn the same 15-minute time period, the application of clinical skills and/ treatment times in excess of 2 hours.one therapist may bill for more than MedicareQ&AMedicare Update Providers should not bill for servicesone therapy service occurring in the or services that attempt to improve function. As indicated above,performed for less than 8 minutes. TheOUR HEALTHmodalities are coded based on thesame 15-minute time period where method of delivery or physical agentexpectation (based on the work valuessupervised modalities are defined applied (e.g. mechanical traction,for these codes) is that a providersby CPT as untimed and unattended electric stimulation, etc.), however,direct patient contact time for each unit not requiring the presence of the therapeutic procedures are codedwill average 15 minutes in length.therapist (CPT codes 97010 - 97028). on the basis of therapeutic outcomeMedicare provides guidance onOne or more supervised modalities intended. With the exception of groupthe reporting of service units thatmay be billed in the same 15-minute therapy (CPT 97150), all therapeuticincludes documentation instructions.time period with any other CPT code, procedures are time-based andThe provider should record the totaltimed or untimed, requiring constant require direct one-on-one contact bytreatment time (or the actual beginningattendance or direct one-on-one patient the physician or therapist (i.e. visual,and ending time of treatment) for[ CODING CONTINUED ON NEXT PAGE ]8 I Fall 2019 www.anjc.info'