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Eli's Rehab Report

Reader Question:

Group Therapy Versus Concurrent Therapy

Published on Fri Mar 01, 2002

Question: Our therapist treats several patients in the same room at the same time, but uses different modalities (for instance, gait training with one patient, whirlpool with the second patient, hand exercises with another ...) She says we shouldnt bill this as group therapy since the patients are performing different tasks, but we think she cant bill for several modality codes for more than one patient if shes the only supervising therapist. Who is right?

Maine Subscriber
 
Answer: Neither is correct. The patients performing different modalities should not be coded using the group therapy code (97150) because patients in group therapy are meant to be working toward the same goal using common procedures. A room that contains a patient walking on a treadmill (97116, Gait training), a patient with her elbow in a whirlpool (97022), and a third patient performing strength training on her hand (97110, Therapeutic exercises), is simply a room with three patients working toward three goals. For these reasons, your scenario does not meet CPTs vision of group therapy.
 
It should be noted, however, that the therapist should not be supervising all patients on his or her own. Billing for these patients separately using their respective codes (gait training, whirlpool and therapeutic exercises) is not appropriate because gait training and therapeutic exercises require direct (one-on-one) patient contact between the therapist and the patient. There is no way that your therapist can provide one-on-one patient contact throughout one patients gait training session while also providing one-on-one contact during another patients therapeutic exercises unless there is more than one therapist in the room.
 
If your insurer or the Office of Inspector General (or a private auditor) came to your office for an audit, they would most definitely make note of this discrepancy and your practice would immediately be on the defensive, so its best to catch this error and stop it from happening before more claims are filed this way.
 Certain therapy modalities do not require one-on-one contact. These supervised procedures allow the therapist to set the patient up with a modality and then stay nearby to ensure that the therapy is being carried out effectively. These procedures include hot and cold packs (97010), mechanical traction (97012), electrical stimulation (97014), vasopneumatic devices (97016), paraffin bath (97018), microwave (97020), whirlpool (97022), diathermy (97024), infrared (97026) and ultraviolet (97028). If your therapist had three patients in a room and one was undergoing whirlpool, another electrical stimulation (unattended), and another a paraffin bath, you would be able to bill for all three of these patients with one therapist supervising. However, you still would not meet the requirements to bill the group therapy code.
 
  Advice for Reader Questions and You Be the Coder was provided by Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.

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