Tia,
97003 is an untimed code. It was never meant to reflect a 15 minute interval.
You may charge for other services on the day of the evaluation. When billing
Medicare, some of the codes may not be utilized together due to the correct
coding initiative (CCI edits). It would seem that the CCI edits wouldn't be in
effect for your situation, so it would, at least on the surface, seem that you
would not have to deal with that issue. For purposes of staff productivity it
would be better to assign a different value to 97003 (i.e. you could denote
evaluations as basic, intermediate and complex and base the number of units
(for productivity purposes only) on the length of time to complete the
evaluation). 96115 is a non-timed code, however it is not traditionally
utilized by rehabilitation professionals in my experience. Most of the
definitions of the physical medicine codes list a condition of direct one on
one contact with the patient. This would preclude use of the code to bill for
documentation time. There is no PMR code for documentation. In the case of
the FWCE, you could bill 97750 at 24 units for a 6 hour assessment. I'm not
certain if use of 99199 would be appropriate in your situation, but I know of
no Medicare intermediary or private insurance that will accept this code.
Average time for evaluation/treatment: That's tough but I suppose 30 minutes
to an hour for evaluation. Treatment sessions generally last 30 minutes to an
hour as well. The CPT codes mandate one on one treatment for most codes, so
generally ordering equipment, documentation, etc. is non-billable but
capturable (not a word - but it fits) time (i.e. you can capture the
non-billable time on your charge master to assist with productivity
determinations). I work primarily in home care and the expectation is 25
visits per week for employees with benefits. I have worked in settings with
reasonable productivity set at 75%. I have also worked in some settings where
the productivity was set unreasonably higher. If productivity is not set too
high, there will be adequate time for non-billable time.
Jimmie
-Original Message-
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Behalf Of [EMAIL PROTECTED]
Sent: Tuesday, April 26, 2005 11:06 AM
To: OTlist@otnow.com
Subject: [OTlist] CPT Codes Workload
Hi everyone,
I have been working inpatient at a VA hospital for several years and have
not had to worry about billing and CPT codes until recently. We are now
having to capture these procedures to justify our time, and the need for
more FTEs, so we need to maximize the number of procedures we report, but
obviously want to keep it legal and ethical.
I would appreciate any info from those in the private sector or other VAs on
the following questions.
1. Must we use only 97003 OT Evaluation for the initial OT visit whether
it's a full or modified eval and takes 15 mins. or an hour or more? Problem
is, we have a lot of 1x visits and it shows up on our stats as 1 unit of 15
mins.
2. If we do above said eval, and in the context of that eval, do w/c or ADL
training, or some other therapeutic procedure, can we add the codes for
those, too, or does it have to be done on a different day?
3. 97750 Physical performance test or measurement and 96115 Neurobehavioral
status exam count for 15 mins and per hour, respectively, with
interpretation and written report. Does that mean, for example, an FCWE
that takes 6 hrs. with the client, and 2hrs. to write the report, would
count as 32 units?
4. Does anyone use the 99199 code to count for documentation time?
5. What is your average time per pt. for an evaluation or treatment, chart
review, documentation, ordering w/c home equipment, etc.?
6. What is the required level of productivity at your facility or in your
work setting?
And, how much time are you allowed for tx. team meetings, staff meetings,
training, in-services, pt./caregiver calls, scheduling, and miscellaneous
office tasks?
Thanks in advance,
Tia Healy
WG Hefner VAMC
Salisbury, NC
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