Oregon Medical Bill Reviewer Training Program

1. Oregon Medical Bill Reviewer Training Program Unit 1: Professional Services Module 7: Physical Medicine Guidelines

2. Hi! In this module, you will learn about physical medicine, patient evaluation, and manipulation. Overview Part I: Physical Medicine • Physical Medicine Guidelines • Patient Evaluation • Manipulation Part I: Physical Medicine • Physical Medicine Guidelines • Patient Evaluation • Manipulation • Modalities • Work Hardening

3. Physical medicine focuses on the diagnosis, treatment, and prevention of illness or injury by physical means. Physical Medicine Guidelines The physical medicine section ranges from 97001 - 97799. Let’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: • Light • Heat & Cold • Water • Electricity • Mechanical Apparatus • Massage • Assessment & Evaluation • Work Hardening

5. Physical medicine patients undergo an evaluation to assess the nature and extent of an injury. Patient Evaluation The type of code used to bill for evaluation services depends on the type of provider. Physical Therapists Occupational Therapists Athletic Trainers Physical Medicine Evaluation Codes Physicians E & M codes There are also medicine codes for tests and measurements that can be billed. Examples include:range of motion testing• functional capacity testing • muscle testing

6. Physical Medicine Manipulation Payment for modalities and therapeutic procedures are limited to a total of three separate CPT coded services per provider, per day, for the same date of service. CPT codes 97001 - 97004 are not subject to this limitation. An additional unit of time (each 15 minute increment) for the same CPT code is not counted as a separate code. Each provider is allowed to bill three physical medicine services per date of service. All subsequent services will be denied.

7. Supervised Modalities Supervised modalities (97010-97028) are only payable when billed with other physical medicine and rehabilitation codes, osteopathic manipulative codes, chiropractic manipulative treatment codes or evaluation and management codes which require constant attendance or knowledge and skill of a licensed medical provider. Supervised modalities will be recommended for payment when billed with procedures 97001- 97004, 97032-97799, 98925-98943 or 99201-99499. If supervised modalities are billed alone or with codes outside of these ranges, the system is automated to deny charges For procedure codes 97010-97028.

8. Time-Based Modalities All modality codes requiring constant attendance (97032, 97033, 97034, 97035, 97036 and 97039) are time-based. Chart notes must clearly indicate when the time treatment begins and ends for the day. If time is not specified, key as billed. The system will default to one unit.

9. Mechanical Treatment When multiple treatments are provided simultaneously by a machine, device or table there must be a notation on the bill that treatments were provided simultaneously by a machine, device or table and there must be one charge.

10. Physical Medicine Testing Mechanical muscle testing may be paid a maximum of three times during a treatment program when prescribed and approved by the attending physician or authorized nurse practitioner: once near the beginning, once near the middle, and once near the end of the treatment program. Additional mechanical muscle testing is paid only when authorized in writing by the insurer prior to the testing. The fee for mechanical muscle testing includes a copy of the computer printout from the machine, written interpretation of the results and documentation of time spent with the patient.

11. Work Hardening Work hardening programs are common methods of treating work-related injuries. Let’s take a look... Part II: Other Services • Work Hardening • Osteopathic Manipulation • Chiropractic Manipulation

12. Work hardening is an individualized, goal-oriented program that assists an injured worker to re-adjust to the physical demands of a job. Each program typically includes conditioning exercises andsimulated work activities tailored to the patient. Work Hardening The American Physical Therapy Association states that work hardening improves: • Strength • Endurance • Movement • Flexibility • Motor control • Cardiopulmonary capacity ...related to the performance of work tasks.

13. 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

14. There are several things you should be aware of when reviewing charges for work hardening. 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.

15. 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 a work hardening program? That’s right! You can verify this information by reading the documentation.

16. Lastly, we will discuss osteopathic and chiropractic manipulation services. Osteopathic Manipulation • Osteopathic Manipulation • Chiropractic Manipulation

17. Osteopathic manipulation focuses on correcting body mechanics and structural abnormalities to treat illness, injury, and disease. Osteopathic Manipulation Osteopathic manipulation codes are: • Limited to Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs). Osteopathic Manipulation codes range from 98925 – 98929. Osteopathic manipulation procedure codes depend on how many body regions are manipulated. Let’s take a look…

18. Head Region Cervical Region Pelvic Region Rib Cage Upper Extremities Thoracic Region Abdomen & Visceral Region Lumbar Region Lower Extremities Sacral Region Osteopathic Manipulation • Body regions include:

19. Chiropractic Manipulation In addition to osteopathic manipulation, there are chiropractic manipulation procedures. Let’s take a look…

20. Chiropractic manipulation focuses on the improvement of joint and neurophysiological function. Chiropractic Manipulation Chiropractic manipulation codes not only depend on the number of body regions manipulated, but whichbody region as well. Chiropractic Manipulation codes range from 98940 – 98943.

21. For CPT 98940 through CPT 98942, regions include:  Cervical Region Thoracic Region Lumbar Region Pelvic Region Sacral Region Chiropractic Manipulation includes atlanto-occipital joint Now let’s take a look at CPT 98943... includes costovertebral and costotransverse joints *Only the most extensive code is allowed to pay.

22. HeadRegion Rib Cage Lower Extremities Upper Extremities Abdomen Chiropractic Manipulation • For CPT 98943, the following regions apply: includes temporomandibular joint excludes atlanto-occipital joint excludes costotransverse joint excludes costovertebral joint

23. Office Visits with Manipulation • If osteopathic or chiropractic manipulation is billed, can E/M also be billed? • Documentation must show that significant separately identifiable E/M services were rendered. Yes!

24. How work hardening services are reimbursed. Summary Physical Medicine: General Guidelines Osteopathic and chiropractic services.