Eli's Rehab Report

Question: Our physical therapist spent five minutes talking to a patient before she began exercising. I think that the five minutes spent talking counts toward the timed therapy codes because they discussed the patient's at-home exercise routine and where the patient's pain is strongest. My therapist thinks that time is not billable. Who is right?

Ohio Subscriber

Answer: You are. If your therapist spent those five minutes assessing the patient's condition and talking about whether the current exercise routine is working, she most likely provided five additional minutes of skilled care.
 
If the patient leaves the room and changes her clothes, you cannot count that toward the therapy time. Likewise, you can't count the time the therapist spends documenting the visit, discussing the patient's condition with physicians or talking to the patient about her daughter's wedding. Only skilled care is billable.
 
If the therapist happens to write in the record while assessing the patient, she can count it as part of the timed therapy code because your practice gets reimbursed for the actual assessment, not the documentation time. The most important factor is to count the time only when you perform actual patient assessment. 
 
Therefore, if your therapist assessed the patient's condition for five minutes and performed therapeutic exercises with the patient for 25 minutes, you can report two units of 97110 (Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) to represent the total time of 30 minutes that you spent performing skilled therapy that day.