Create a Physiotherapy Bill Format for Entertainment Effortlessly

Physiotherapy bill format for Entertainment

billing is a necessary part of what we do because our employer has to be able to bill insurance companies and um bill payers in order to get the money to pay us so we want to make sure that we're billing accurately we're using the appropriate codes because your billing department in your clinic or hospital where you work can bill an insurance company but they can deny the charge for any number of different reasons for not using the right codes or for not doing the billing units right and so it's something that we're kind of just starting to learn about in school and you'll hear more and more about it as you go out into the clinic so i'm just going to do an overview of cpt codes which are the codes that we use and billing units and we're going to keep talking about it during the program so if you feel up in over your head a little bit on this that's okay we're just starting out so cpt codes are um are codes that are established by the american medical association for providers health care providers to bill for services so the learning objectives for this presentation are to be able to report the appropriate cpt code for each pt intervention you learn so in our procedures classes we're learning new interventions and so you want to know what is the appropriate cpt code for each of the interventions that we learn and we also want to be able to accurately record the billing units for each treatment session so the thing that happens probably more often than not is you do not bill for everything that you do um so we need to accurately record and accurately bill for what we actually do because you want to get paid for what you're doing so that was one of the biggest lessons i learned when i was right out of school well right out of school i worked in an outpatient clinic and they told us what to bill they said build this do this build this so that made it easy but then when i moved into another setting i moved into a sub-acute setting at my first performance review my manager said you need to learn how to do your billing better i need to do it more efficiently and she gave me a lot of good tips and one of the things that she said is you're not billing for everything that you do so the time that you spend with the patient you need to make it billable time you need to make every minute you spend with them skilled therapy and billable time and that's how you get your productivity numbers higher and that's how you get paid for what you're doing so i actually used to walk around with a stopwatch around my neck and i would time every single thing i did and i would write every single thing down until i got the hang of it so that was a very useful experience for me because i learned how to do the timing on the billing so it's really important now i can wing it a little bit more because i've been doing it for a long time but um the stock watch was super helpful to start out so cpt codes um are published by the american medical association and they put out updates every now and then and i think the most recent update was 2018 i want to say um and it's listed in the at the end of the presentation under references um throughout the cpt code set they use terms like physician qualified healthcare professional individual and that's not intended to say that only a physician can report the service for our purposes it's the licensed pt or pta reporting the service so when they say um qualified professional or provider they're talking about you so you're the provider you're the provider of the service so um i'm going to talk about the cpt codes that will mostly use in the classes that you have in the program not to say that there aren't other cpt codes there are um but between um 97110 and 97140 in that range are usually the ones that we use for therapy so occupational therapy has a little bit of crossover in that and then they have other ones that we don't use so an occupational therapist can bill for vision therapy because that's one of the specific things that they're trying to do but we can't bill for vision therapy because that's not under our scope of practice um and certainly there are um codes for physicians that they can build for bill for that are under their scope of practice that aren't under ours so we're just talking about the ones that are relevant to physical therapy um so a therapeutic procedure is a manner of affecting change through the application of clinical skills or services that attempt to improve function how's that for a definition that's straight out of the ama so the therapist is required to have direct one-on-one patient contact in order to bill for therapeutic procedures the only one procedure that you can bill for that doesn't require one-on-one contact is group therapy and i'll talk a little bit about group therapy but group therapy requires constant attendance but not one-on-one patient contact okay starting out there so i'm just going to talk about commonly used codes in pt and some of these you have encountered in each of your classes so in your acute care class um therapeutic exercise came up and some other ones probably in um your modalities class we're going to talk about a few more talking about codes for specific modalities um in your neuroriad class we're going to talk about a few more so we're kind of adding them on little by little until you get your little galaxy of charges um and i'll talk about just the variations in charging in a few minutes so 97110 is therapeutic exercise that code one unit of therapeutic exercise is 15 minutes um so therapeutic exercises are exercises to develop strength endurance range of motion or flexibility in any given body part so um [Music] so if we do do therapeutic exercise we'll say therapeutic exercise to improve strength and range of motion in the right lower extremity that's how we're going to write it and then we're going to say what we did if that was that so we say the code why we did it and what we did that's in our treatment section okay so 97112 neuromuscular re-education it's also a 15-minute code so codes are either one unit is 15 minutes or they're untimed meaning that um if you do that at all you charge one of it and then it's for any amount of time so an untimed code if you do it for an hour you charge one unit or you have to do it for 15 minutes you charge one unit so some of the evaluation codes which we don't use as ptas um are timed different times and some of them are untimed but most of the codes we use besides group therapy are timed and a few of the modality codes are untimed so 15 minutes is the time we're talking about um neuromuscular re-education is re-education of movement balance coordination kinesthetic sense posture and or proprioception for sitting and or standing activities so if you have someone you're treating someone with an ankle injury and you're using the baps board to re um retrain their kinesthetic sense and proprioception and balance you're doing neuromuscular re-education um on a mini trampoline on a swiss ball using the body blade doing proprioceptive neuromuscular facilitation doing ndt or any of the other neuro re-education um tools that you will learn more about in your neuro rehab class but basically it's some neurological sense like posture balance coordination kinetic sense that we developed when we were children and then we lost it somehow through illness or injury and then we have to re-educate that um neuromuscular re-education interesting right aquatic therapy sounds obvious right you're doing therapeutic exercise in the water it has a different code because you're in the water 97113 it's a 15 minute unit um gate training 97116 also 15-minute unit gait training um includes stair climbing so you're trying to improve safety increase independence you're trying to restore normal gait all of those things are appropriate for gait training lots of different activities um are included in gait training so it's not just walking it's gate training it's um it's a it's encompassing lots of different activities 97140 is manual therapy techniques so mobilization manipulation manual lymphatic drainage manual traction 15-minute unit the type of treatments that we're doing that qualifies manual therapy are soft tissue mobilization myofascial release serial compression bandaging um for lymphedema which we'll all we'll learn in fall quarter um and joint mobilizations those are manual therapy so um it's a lot of the hands-on thing and so we're going to be doing a mobilization to improve joint mobility or manipulation to improve joint mobility manual lymphatic drain drainage to reduce swelling manual traction to for lots of different reasons to improve joint mobility or decrease pain or increase flexibility so we're going to say why we did it so we're going to say soft tissue mobilization to promote tissue healing through increased circulation that's a really good reason for doing soft tissue mobilization so with each of the techniques that we are going to learn and we will talk about why you do it so what the why of why you do it is clinical indications why is this treatment indicated why are we going to do it and what are we going to charge for it so group therapy okay this may sound obvious but the definition of a group is two or more individuals and the therapist doesn't count so if you only have one person you cannot charge group therapy you have to have at least two patients and one therapist to charge group therapy and that may sound obvious but some people don't get that so group therapy procedures involve constant attendance of the therapist but they don't require one-on-one patient contact by the same therapist it's and it's an untimed code so if you do group therapy for an hour you don't charge four units for 15 minute units you charge one because it's an untimed code so examples of group therapy it's not what the patients are doing that determines whether or not it's group therapy or one-on-one treatment it's what the therapist is doing with the patients so how is the therapist treating the patients is the therapist or assistant one-on-one with one patient while the other patients are doing some sort of exercise or intervention independently or under supervision or are they in constant attendance of both patients providing a skilled intervention with no measurable amount of direct one-on-one time spent with either patient so if if you're doing one-on-one with one patient you can't be doing group with the others you have to be paying attention to all of them on some levels so sort of multitasking so i'll give you an example so i have three patients they all had knee replacements they're all coming in at 9 30 to be in the joint replacement group they have a list of exercises that they do and they have pictures and descriptions of all the exercises and i am monitoring the group and leading the group basically so when the patients come in i say hi bob sue and lynn bob i'm gonna have you on the bike lynn you're gonna be on the new step and sue you're also gonna be on the other new step so let's get started so everybody gets on i help them adjust the equipment appropriately for them each person and then they all start and they do their bike or their new step for eight or ten minutes and then i say okay um bob you're going to be on that table sue you're going to be on that table and lynn you're going to be on that table and i want you start with this exercise you start with this exercise and you start with this exercise so they start and as they're working i might go around and do some corrections um and i might um they or they ask me a question i answer a question um and then i help work them through their exercises i'm not spending any more than five minutes one-on-one with any one patient i'm monitoring and working with the whole group okay um here's the here's an example that's group therapy and i'm going to charge one unit of group therapy for each of those patients even if they were there for an hour or 90 minutes um here's another example they same three patients come in and um bob says boy my leg is really swollen today um and i'm like okay let's get everyone started so i get them on their equipment and then i take bob over to the mat table and i do 10 minutes of manual lymph drainage while the other two are on the bikes i can charge one unit of manual therapy for bob but i can't charge anything for lynn and sue while i'm working one-on-one with bob because i'm working one-on-one with bob i can't be paying attention to those other two because i'm one-on-one so um and it has to be one-on-one and group are distinct procedures you can't be doing them at the same time so that's kind of the difference between one-on-one versus group therapy so in a group setting you're doing no measurable amount of direct one-on-one time spent with any of the patients um you might have a therapy team where one therapist is doing one-on-ones with people and one therapist is doing the group so i've seen group programs in several different settings outpatient inpatient subacute and the main commonality between all of those is you're not doing direct one-on-one treatment with any one patient you're supervising all of them at once okay so you might run into a group therapy program in one of your settings and it's not what the patients are doing that makes it group it's how the therapist is treating them that makes it group so the therapist or assistant is in constant attendance of two or more patients providing skilled therapy and interventions but not providing any significant amount of measurable one-on-one time to either patient whether on land or in an aquatic setting so you can have like a group exercise class in the water a group aquatic therapy charged under group but you're not doing one-on-one with any one of those patients so um each patient is billed one unit of nine um 97150 group therapy is a service based rather than a time-based cpt code and um so you're not even if they're there for an hour you're not charging them four units okay therapeutic activities it's of course direct one-on-one patient contact use of dynamic activities to prove improve functional performance so functional is the key here it's a 15 minute code so lifting carrying pushing pulling pinching grasping crawling climbing lunging throwing catching you can read all those or simulation of functional activities like car transfers a lot of times in the hospital before someone leaves we simulate a car transfer we have a car and we do a simulated car transfer just to make sure that person can successfully get in and out of their car when they leave the hospital so that's a therapeutic good example of therapeutic activities may also include bed mobility and transfer training um so it involves the use of a functional activity to restore functional performance in a progressive manner so i always say with bed mobility and transfers the main difference is it has to be a skilled intervention so the pta is not transferring the patient they are teaching the patient to get better at transferring themselves that's what makes it a skilled intervention versus i'm just going to move you from one place to another um same thing with bed mobility i'm not just going to roll you over onto your side i'm going to work with you to improve your ability to roll over onto one side by yourself so that's the difference between skilled therapy and just moving a patient around so um self-care and home management training some insurance companies reimburse for this and some do not so you should know before you charge this code whether or not your patient is going to get charged for it or their insurance company is going to pay for it so um really it involves improving someone's activities of daily living compensatory training a lot of the things ots do like meal preparation use of adaptive instructing them how to use adaptive equipment this is probably more ot related than pt related but if you're teaching someone pain management techniques or how to use home modalities for pain management that could be self-care or home training um so bathing grooming dressing personal hygiene basic household chores cooking using appliances and medication management so a lot of those are kind of ot related so there's where the ot and pt crossover um but it is possible that we could be doing this the other thing is um teaching caregivers how to help the patient so that could be a self-care home management training um code as well probably not as common and in our classes um that we're doing in the program we're probably not charging that code i'll just tell you that wheelchair management is another one that we're probably not charging all that often um assessment fitting and training it's a 15-minute code includes wheelchair evaluation performed by a pt or ot so ptas don't usually do that um but testing the patient's ability with various chair functions like can they propel it themselves using their arms can they propel it themselves using their legs also adjusting or determining types of seat cushions back support head and neck support armrest leg rests etc that's wheelchair management and training the patient and their family in use of the wheelchair so um depending on the setting that you work in you may or may not encounter using this code and the type of patients in your caseload so commonly used ones that we're going to use a lot in the program are 97110 therapeutic exercises 97112 neuromuscular re-ed i always say the one that's not on this list um well gate training's on there i always say like one therax one neuro one gate that's a um that's a neuro patient charge for sure you had a 45 minute appointment you did one there's one neuro weight gain but um most of the modality treatments that we're going to do in pta 111 like ultrasound electrical stem manual therapy like soft tissue mobilization um those we use those are the ones we're going to use commonly in that class electrical stimulation there are two um group therapy is untimed and there are two modalities treatment that are untimed if you if you put electrodes on someone give them a bell and walk out of the room that's unattended electrical stim and that is an untimed charge so it doesn't matter if they're there for 10 minutes or an hour you charge one unit um mechanical traction is another one that's untimed so um [Music] that's that's just the way it is that's the way it's defined by the ama um so a lot of times because i work with a neurocase load a lot of times i'm doing electrical stim for neuromuscular re-education so i don't charge it under electrical stem i charge it under neuromuscular re-education for um neuromuscular facilitation kinesthetic sense proprioception you know lots of different reasons to use that so that having been said billing is an art rather than a science um physical therapy billing can change depending on what the purpose of your treatment is so a lot of physical this is a quote from a billing specialist most physical therapy practices under bill and use the wrong codes and therefore get underpaid it's common seeing therapists spend over an hour with the patient and only bill for two to three units of care so if a unit of care is 15 minutes and you're spending an hour with the patient you need to bill for four units of care meaning you have to give them four units of um skilled therapy so if you're if you're not doing that they're not getting their money's worth and you're not getting paid enough so um so it's really important to make sure that you're doing skilled therapy the whole time and you're billing appropriately for it so any one thing you do could be billed under different codes depending on the reason you have for doing it so if you recall if you listen to the soap note lecture and you recall in the um treatment section i said you need to say what you did and why you did it um so the why you did it is what determines your cpt code so this is an example of showing a patient how to perform an oblique abdominal sit-up okay we've all done those maybe you did it earlier today i didn't i did it yesterday anyway if you're teaching a patient this exercise for the purpose of increasing their strength and flexibility which i believe is the reason i did it yesterday you can build cpt code 97110 therapeutic exercise easy squeezy right so if it's in the plan of care if therapeutic exercise is in the plan of care and increasing the patient's strength and flexibility bam you got it okay however if you're showing the patient the exercise for the purpose of facilitating disassociative movement between lumbar and thoracic segments therefore thereby improving proprioception you can bill the code 97112 neuromuscular re-education or if you're doing the exercise for the for the reason of um improving axial um mobility to decrease rigidity because they have parkinson's disease 97112 it's neuromuscular re-education you're not doing it just to get stronger and more flexible you're doing it to re-educate the nervous system and that's why we're charging neuromuscular education if you're showing the patient the exercise for the purpose of improving the functional performance of getting out of bed because you need to do that get out of bed you can build 97530 therapeutic activities because that's why you're doing it so there are a variety of ways you can bill for the procedure and depending on your intent there's the proper cpt code to use but you have to make sure to justify your treatment intentions and document them properly in order to avoid problems later so if in your treatment section you said um instructed patient in abdominal oblique set up to improve functional performance in getting out of bed that's a nice statement right there um you are going to charge 97530 therapeutic activities if you said um instructed patient in abdominal oblique abdominal sit-up to improve upper and lower trunk disassociative movement to decrease axial rigidity sure 97112 so document what you did why you did it and that should tell you which code you should use it sounds easy when you say it that way doesn't it maybe not as easy in real life so in terms of billing units so i talked about like you you have someone for an hour you should build four units so really a basic unit is 15 minutes so by definition one unit is 15 minutes however there are ranges of minutes that qualify as 15. so you can think of it as 15 plus or minus certain things so one unit is anything equal to or greater than 8 minutes or less than 23 minutes so if you do 22 minutes of something you cannot charge to two units for it you can only charge one if you do it for one more minute you can charge two because two units is greater than or equal to 23 minutes and less than 38 minutes so if you have 45 minute appointments in your clinic like clinic i work in right now has 45 minute appointments you better be doing skilled therapy for at least 38 of those 45 minutes if you're going to build three units because three units is greater than or equal to 38 minutes and less than 53 minutes if you have hour-long appointments you better be doing at least 53 minutes of skilled therapy and up to less than 68. five units 68 to 83. it's rare that you're going to be billing more than four or five units but um in certain settings you might so if you have 30-minute appointments you better be doing skilled therapy for at least 23 minutes so you can build two units a lot of times um in your practicals and in class you'll have a 25 minute treatment that means you're doing something you can build two units for so if you start thinking in units start thinking in 15 minute increments that helps you um come come up with this so okay i'm just going to leave it right there for the eight minute rule so we'll just keep talking about this and we'll keep but when you're when you're starting to write down how many minutes you did something bear this in mind um if if you did something between 8 and 22 minutes it's one unit if you did less than eight minutes of something you cannot bill for it so there's that too so there's sometimes when i'm doing something in conjunction with the treatment and i'm certainly documenting of course but it takes less than five minutes to do of course i'm not gonna charge for that if i put kinesio tape on someone and it just takes a couple minutes um i'm not charging for that i'm documenting it but i'm not charging for it crazy right so for time-based codes you must provide direct treatment for at least eight minutes in order to re um receive reimbursement from insurance including medicare um when the insurance company is calculating the number of billable units for a particular date of service they add up the total minutes of skilled one-on-one therapy and they divide the total by 15. so if eight or more minutes are left over then you can build for one more unit if seven or fewer minutes remain then you can't bill for an additional unit so if i had um 40 minutes of skilled one-on-one therapy and i divide that by 15 um i get two and um so two 15-minute units that's 30 minutes and then i get 10 more minutes so that 10 minutes i can bill for that third unit does that make sense so um that's kind of how they figure out the eight minute rule so just think of things in chunks of 15 minutes but think of the 15 as plus or minus a few and then we'll keep talking about this and hopefully it'll start making sense so this is the references that was the cpt changes in 2018 that was kind of the most up-to-date one and um if you ever want to read some really exciting documentation you can get it from the american medical association you can even subscribe to that