DavitaBrannon03
Contributor
Hello All!
I started PT codeing after the functional reporting rules changed for Medicare last year, so we are late making the transition. I am having a tough time explaining to the therapists the requirements for the eval, re-eval, 10th visit and discharge claims. I understand what it is that Medicare is looking for as far as the functional codes that should be included on the before mentioned encounter types. I have pulled every piece of information that I can find fro mthe CMS website, but they are still unclear.
The main issue I'm having are the discharge visits. I am unable to explain that there should be a prognosis code that corresponds with the discharge code included on the claim. I think what I need is a good reason why they are included (other than: that's how Medicare wants it, lol). The rebuttal I'm getting is that the PT cant predict the future so there should't be a prognosis code.
The way I understand it is: the prognosis code is determined during the initial eval. This code can either remain the same throughout treatment or if during a re-eval or 10th visit the PT deems that the pt will progress farther than the original goal then the corresponding functional code can change accordingly, but it must be included with the corresponding discharge code at the time of discharge.
Someone please let me know if I'm understanding the concept correctly or not. Sorry this was so long winded :/ and thank you in adnvance!
Davita Phillips CPC-A
I started PT codeing after the functional reporting rules changed for Medicare last year, so we are late making the transition. I am having a tough time explaining to the therapists the requirements for the eval, re-eval, 10th visit and discharge claims. I understand what it is that Medicare is looking for as far as the functional codes that should be included on the before mentioned encounter types. I have pulled every piece of information that I can find fro mthe CMS website, but they are still unclear.
The main issue I'm having are the discharge visits. I am unable to explain that there should be a prognosis code that corresponds with the discharge code included on the claim. I think what I need is a good reason why they are included (other than: that's how Medicare wants it, lol). The rebuttal I'm getting is that the PT cant predict the future so there should't be a prognosis code.
The way I understand it is: the prognosis code is determined during the initial eval. This code can either remain the same throughout treatment or if during a re-eval or 10th visit the PT deems that the pt will progress farther than the original goal then the corresponding functional code can change accordingly, but it must be included with the corresponding discharge code at the time of discharge.
Someone please let me know if I'm understanding the concept correctly or not. Sorry this was so long winded :/ and thank you in adnvance!
Davita Phillips CPC-A