Eli's Rehab Report

You shouldn't bill twice for the same work, experts say.

Question: Our outpatient clinic is working with a stroke patient who was just discharged from a rehab facility. Our therapists are treating the patient for deconditioning based on an order from the medical director at the inpatient facility. However, the patient then followed up with his physician, who sent an order for evaluation and treatment for left-side weakness following stroke. Now that the ordering physician has changed, our business office wants us to discharge the patient and then reevaluate him. Is this necessary?

Answer: No, "there is no new diagnosis to evaluate," so you shouldn't attempt to charge for a new evaluation, says Wade Anderson, PT, with Alliance Physical Therapy in Eugene, Ore. And many payers will only cover evaluations on a specific body part or for a specific diagnosis once per 12-month period, points out Diane McKeon, a billing consultant in Whitinsville, Mass.

Better: If the ordering physician changes during a patient's course of treatment, you can simply change the doc's name in the medical record and continue with the care plan, Andersons suggests.

And if the original physician hasn't discharged the patient or might still be working with the patient, you should send a note to both docs alerting them that you have two orders for the same diagnosis. Ask them to let you know who will be following the patient's care. That should be the name recorded in the patient's chart, Anderson says.