Orthopedic Coding Alert

Question: Our physical therapist documented gait training for a motor-vehicle accident patient and referred to "maintenance" in her notes. Our office manager thinks the service isn't payable because Medicare doesn't reimburse maintenance therapy, but the therapist disagrees. How can we determine the difference between maintenance and non-maintenance therapy?

Tennessee Subscriber

Answer: If your patient has already met all of her rehabilitation goals and no longer shows any progress, your carrier will probably consider the gait training "maintenance" and refuse to pay.

According to Blue Cross and Blue Shield of Tennessee's policy, gait training is a skilled service (and therefore may be payable) "if the patient's ability to walk has been impaired and when training can be expected to significantly improve the patient's ability to walk."

The carrier considers gait training non-skilled "after the gait has been taught and the goal is merely walking to improve distance or endurance."

Some payers, including Tennessee's, will reimburse maintenance for periodic evaluations to determine whether the patient has responded well to treatment, but these services are payable only on a case-by-case basis.

If your therapist believes that she performed skilled therapy but your office manager disagrees, the therapist might not be documenting her services thoroughly enough. She should always record the patient's diagnoses, symptoms and impairments, and how the gait training helps her improve the patient's condition.