ortholg@yahoo.com
Guest
In the Ingenix book, Coding for the Physical Therapist (Coding and Payment Guide), a Coding Tip is provided which states, "..According to CMS guidelines, at least 8 minutes of direct contact with the patient msut be provided for a single unit of service to be appropriately billed."
One of our Physical Therapists has coded a 97140 (Manual Therapy, each 15 unit), but has documented in his progress note that he only spent 5 minutes on this. I am wondering if this can be billed at all, since the above does state that an increment must be at least 8 minutes. When I spoke to another therapist, THEY said not everyone has to adhere to those specific guidelines.. Only FEDERALLY FUNDED insurances will enforce those guidelines she said.. (e.g., Medicare, Medicaid).
I was surprised with that response because I know all the other payers use the CPT guidelines for our regular Orthopedic codes. For instance, BCBS or MVP etc.. they all follow the same CMS guidelines on our E/M codes that are in the CPT books, etc.
I've never coded P.T. before.. Anyone out there who can steer me in the right direction?
One of our Physical Therapists has coded a 97140 (Manual Therapy, each 15 unit), but has documented in his progress note that he only spent 5 minutes on this. I am wondering if this can be billed at all, since the above does state that an increment must be at least 8 minutes. When I spoke to another therapist, THEY said not everyone has to adhere to those specific guidelines.. Only FEDERALLY FUNDED insurances will enforce those guidelines she said.. (e.g., Medicare, Medicaid).
I was surprised with that response because I know all the other payers use the CPT guidelines for our regular Orthopedic codes. For instance, BCBS or MVP etc.. they all follow the same CMS guidelines on our E/M codes that are in the CPT books, etc.
I've never coded P.T. before.. Anyone out there who can steer me in the right direction?
