Eli's Rehab Report

Private practices in VA, SC, NC, and WV go under the microscope.

Heads up: Palmetto GBA will be conducting an outpatient physical therapy probe for private practices in Jurisdiction 11. Practices in West Virginia, Virginia, North Carolina, and South Carolina, will undergo review for the following CPT Codes :

• CPT 97113 (aquatic therapy)
• 97110 (therapeutic exercises)
• CPT 97530 (therapeutic activities)
• 97140 (manual therapy)
• 97112 (neuromuscular reeducation)
• 97116 (gait training)
• 97032 (electrical stimulation)
• 97016 (vasopneumatic devices)
• 97150 (group therapy)
• 97012 (traction)
• 97535 (self care/home management training)
• 97035 (ultrasound)

A recent data analysis by Palmetto revealed 12 private practice settings billing a "significantly" high number of these codes. "Claims review will be performed on approximately 100 claims per state for each of the procedure codes selected," Palmetto announced.

The writing on the wall: All therapy organizations should take this probe as a warning.

"We are starting to see more pre-payment audits in the profession [and] I suspect that will only get worse," notes Meryl Freeman, MS, PT, manager of outpatient rehab at Rex Healthcare in Raleigh, N.C.

Best bet: Don't cut corners on billing and documentation. "If physical therapists are doing what they should be doing, they should not have anything to worry about," says Flo Moses, PT, MS, LAT, ATC, president of Sports & More Physical Therapy, Inc. in Raleigh, N.C. Having systems in place to supporting medical necessity is key -- and for all patients, not just Medicare, she says.