Are your therapists becoming habitual in coding their treatment interventions? Do they understand how to accurately and correctly code the services they provide? 2018 brings further changes in CPT (Current Procedural Terminology) code reimbursement rates; thus, raising an important question: Are therapists properly coding to ensure accurate reimbursement while upholding ethical standards of practice?
In continuing our discussion regarding Medicare and regulatory changes in the new year, it is imperative to understand that there are several different codes that a therapist can select when billing a client for services rendered. It’s important for therapists to know whether they are selecting the most applicable and appropriate code to ensure proper reimbursement while executing ethical practice patterns. This particular change in coding is one of which will effect those therapists in outpatient, private practice, SNF’s (Medicare B), outpatient hospitals, home health (Medicare B) and other rehab providers.
CPT codes are used by healthcare professionals to code and bill for the interventions they provide. Let’s first discuss why CMS has implemented these changes. According to the American Physical Therapy Association (APTA), the change in the CPT code fee schedule that went into effect on January 1st 2018 was in a response to the “American Medical Association’s Committee’s recommendation on potentially misvalued codes associated with a wide range of professions,” including, but not exclusive to therapy. Whether you are a Physical Therapist (PT), an Occupational Therapist (OT) or a Speech-Language Pathologist (SLP), your skilled interventions will fall into a specific category for billing and coding purposes and it is vital to understand how to code interventions properly to ensure efficacy and the residual impact of the change in the fee schedule.
Let's Dive Into Some Specifics
Below is a chart of commonly used therapy codes in the DC/MD/VA suburbs geographical region and the subsequent changes in fees from 2017 to 2018.
If therapists have pre-established practice patterns for billing based on their client case load or pre-existing routine habits for coding, there will be some associated cost changes, some of which may be drastic depending on the therapeutic setting and related trends. For example, if a therapist routinely bills for an hour session (30 minutes of therapeutic exercise and 30 minutes of manual therapy), one can see the significant impact in reimbursement this may have in 2018 vs. 2017 when referring to the changes in fee schedule. Therapists must be cautious and understand exactly what the codes mean, as well as being able to analyze what specifically they are doing to ensure proper billing and coding. Therapists should document precisely what they are doing with the client, and bill for the exact skilled component of that treatment. It is vital that therapists understand the task they are facilitating and the purpose in order to code it correctly. For example, if an occupational therapist is completing a functional mobility task, and billing under therapeutic exercise, this is not being coded correctly and can have an impact on billing and reimbursement. Is the client performing mobility in order to safely retrieve items from his/her closet in order to get dressed? The task should then be coded under ADLs/self care, which has a different associated fee. Another example, let’s say, a PT is completing standing exercises with 2lb weights with a long-term goal to improve balance for reduced fall risks, and is billing this task under therapeutic exercise. PTs need to re-evaluate and re-analyze exactly what skilled care they are providing and code it as it should be. If the ultimate goal is to increase balance and they are using weights to improve weight shifting and lower extremity strength in standing this could be coded under Neuro Muscular Re-education which has a different fee schedule attached to it.
Many of the codes that PT and OT often use (therapeutic exercise, therapeutic activities, manual therapy) have had significant changes in the allowed amount whether an increase or decrease. Therapists need to be aware, and be honest in what they are doing, but also consider this. Certain therapists may have developed routine practice patterns in their daily sessions, but then all of a sudden, the therapist changes how they usually bill and code his/her session; this could also raise a red flag. Based on the updates to the fee schedule, if there were sudden changes, an auditor could assume, they may be billing upward to secure the higher reimbursement rate. One must remember, be informed, analyze the task, understand the means of the code, document the specifics of what the therapist is facilitating for the client, and for what purpose in order to code and bill accurately.
Because of the variations in upward and downward adjustments, as well as the practice patterns of one’s client caseload/setting, it is impossible to make a general statement of how therapy providers will ultimately be affected; however, overall, CMS does predict a 1-2% reduction in reimbursement. It is also possible; however, some providers may see an upward trend.
Bottom line: It is imperative for providers to understand how to code properly and the resultant changes in the fee schedule to accurately depict the skilled service code. These changes are presently in effect; billing under an inaccurate code could have an impact in reimbursement and compliance. One thing for sure, if a provider is competent and honest in his/her provided services, the change in the fee schedule should not have a detrimental effect. Honesty is always the best policy, but one must also be properly informed in order to do the right thing.
Let us help you embrace the 2018 changes with an open, unfearful mind.
Concerned that your therapy practice is not delivering and coding care to the best of its abilities? Let LW Consulting, Inc. perform an audit of your therapy documentation and provide training to ensure your practice is in total compliance.