Know the OT Procedures You Can Bill for to Receive Proper Payment
Published on Sun Oct 01, 2000
Neurology practices that erroneously classify all therapy services as physical therapy may be shortchanging their patients by assuming that occupational therapists are able to bill only a few CPT Codes . In reality, occupational therapists can perform and bill a wide range of codes, and some neurology practices can benefit by employing occupational therapists on staff.
As an integral part of most patients rehabilitative treatment, occupational therapy (OT) is recognized as a way to help patients regain independence after suffering from an impairment, such as a spinal cord injury or a stroke (436), or while learning to adjust to a disease, such as multiple sclerosis (340). The American Academy of Neurology recently recommended OT evaluations and early treatment for many children suffering from autism (299.0x).
Few Limits to OT Coding
Because OT services are not restricted to what some billers view as OT codes, such as the codes 97003 (OT evaluation) and 97004 (OT reevaluation), CPT 97535 (self care/home management training [e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment] direct one on one contact by provider, each 15 minutes) and 97537 (community/work reintegration training [e.g., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis], direct one-on-one contact by provider, each 15 minutes), neurology practices employing occupational therapists should learn the full range of their services so billers can more accurately code these therapy claims.
With the exception of the 97001 (physical therapy evaluation) and 97002 (physical therapy reevaluation) codes, there are no national limitations to rehabilitation codes that occupational therapists can use, says Judy Thomas, director of the reimbursement and regulatory policy department of the American Occupational Therapy Association in Bethesda, Md. Although there may be state practice act restrictions on some codes, she says, occupational therapists can bill for most codes from the physical medicine and rehabilitation section of CPT, and there are no designations in the CPT regarding which codes should be billed by physicians, physical therapists, occupational therapists or speech therapists.
Procedures Beyond Physical Therapy
It is a misconception that any one procedure or code, other than the physical therapy evaluation and reevaluation codes, should be designated physical therapy, Thomas explains. She notes that payers and clinicians sometimes refer to physical therapy as a generic expression for rehabilitation services, but a clearly written plan of treatment usually can justify any therapists billing for these services.
In fact, says Thomas, occupational therapists often bill codes outside of the physical medicine and rehabilitation section of CPT. For example, an occupational therapists evaluation of a patient recovering from a stroke might involve performing codes 95851-95852 (range of motion measurements) and 95831-95834 (muscle testing) to help appraise [...]
