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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Usual and Customary Training – Physical Medicine July 2011
Overview
Hi! In this module, you will learn about physical medicine, acupuncture, and
manipulation. Let’s 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
Usual and Customary Training – Physical Medicine July 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. Let’s take a look…
Usual and Customary Training – Physical Medicine July 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
Usual and Customary Training – Physical Medicine July 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 TherapistsOccupational 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
Usual and Customary Training – Physical Medicine July 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. Let’s take a
look...
Usual and Customary Training – Physical Medicine July 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.
Usual and Customary Training – Physical Medicine July 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
Usual and Customary Training – Physical Medicine July 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.
Usual and Customary Training – Physical Medicine July 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?
That’s right! You can verify this
information by reading the documentation.
Usual and Customary Training – Physical Medicine July 2011
Acupuncture
Let’s take a look…
Acupuncture services are subject to
guidelines as well...
Usual and Customary Training – Physical Medicine July 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
Usual and Customary Training – Physical Medicine July 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.
Usual and Customary Training – Physical Medicine July 2011