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Coding TIP:

Add Up Your Therapy Claims With These Coding Equations

Published on Wed Mar 14, 2007 Print Friendly and PDF PDF

Learn when therapy-only doesn't mean 'no nursing.'

Until something definitive in writing on the use of V57.x codes comes from the Centers for Medicare & Medicaid Services or appears in the American Hospital Association's Coding Clinic for ICD-9-CM, many home care agencies exclusively list codes from this series for therapy-only patients.

If you fall into this camp, Jun Mapili, PT, MAEd, rehab therapies supervisor for Global Home Care in Troy, MI, shares the following coding equations to help you decide when to use a V57.x code and which one to use.

  • Physical therapy + occupational therapy + no nursing = V57.89 (Multiple training or therapy) as primary.
  • Speech therapy + physical therapy + no nursing = V57.89 as primary.
  • Speech therapy + occupational therapy + no nursing = V57.89 as primary.
  • Speech therapy + no physical therapy + no nursing + no occupational therapy = V57.3 (Care involving use of rehabilitation procedures; speech therapy) as primary.
  • Physical therapy + no nursing + no other therapy = V57.1 (Care involving use of rehabilitation procedures; other physical therapy) as primary.
  • Occupational therapy + no other skilled disciplines involved in the recertification = V57.21 (Encounter for occupational therapy) as primary.
  • Speech therapy + nursing = List the underlying or proximate diagnosis as primary.
  • Physical therapy + nursing = List the underlying or proximate diagnosis as primary.
  • Physical therapy + occupational therapy + nursing + speech therapy = List the underlying or proximate diagnosis as primary.

Don't miss: If your agency uses a nurse to admit a patient for therapy services, the case can still qualify as therapy-only, Mapili says. Doing an admission (completing the OASIS, signing documents and completing initial comprehensive documentation) for the therapy is not a qualifying service under the home health PPS, so using a V57.x code is still appropriate in this scenario.

Another twist: Even if your agency is providing home health aide services in addition to therapy, you still have a therapy-only case. If your therapists are unable to supervise the aide according to your state practice acts, providing an RN to supervise is an administrative cost and not billable as a skilled visit.

If venipuncture is the only skilled service provided by the nurse, and therapy is the qualifying service, the case is still a rehabilitation case, and the V57.x codes would apply, notes Mapili. Venipuncture or blood draw done by a nurse is a skilled procedure, but not a Medicare qualifying service, he says.

Heads up: If you know about the entry of the nurse at the start of care, then the RN must perform the OASIS.

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