Pennsylvania Medical Bill Reviewer Training

1. Pennsylvania Medical Bill Reviewer Training Unit 1: Professional Services Module 7: Physical Medicine & Manipulation

2. Overview Hi! In this module, you will learn about physical medicine, acupuncture, and manipulation. Part I: Physical Medicine • Physical Medicine Guidelines • Patient Evaluation • Acupuncture • Manipulation Part I: Physical Medicine • Physical Medicine Guidelines • Patient Evaluation

3. Physical medicine focuses on the diagnosis, treatment, and prevention of illness or injury by physical means. Physical Medicine Guidelines The physical medicine section ranges from 97001-97799. Let’s take a look…

4. Physical Medicine Guidelines • Physical medicine services encompass many different types of treatment. Physical medicine includes the use of: Physical medicine also involves services such as: • Light • Heat & Cold • Water • Electricity • Mechanical Apparatus • Massage • Assessment & Evaluation • Work Hardening

5. Just like other types of services, physical medicine patients undergo an evaluation to assess the nature and extent of an injury. Patient Evaluation The type of code used to bill for evaluation services depends on the type of provider. Physical Therapists Occupational Therapists Athletic Trainers Physical Medicine Evaluation Codes Physicians E & M codes Additionally, there are medicine codes for tests and measurements that can be billed. These may include things like:range of motion testing• functional capacity testing • muscle testing

6. Work Hardening Work hardening programs are common methods of treating work-related injuries. Let’s take a look... Part II: Other Services • Work Hardening • Acupuncture • Osteopathic Manipulation • Chiropractic Manipulation

7. Work hardening is an individualized, goal-oriented program that assists an injured worker re-adjust to the physical demands of a job. Work Hardening • Each program typically includes conditioning exercises and simulated work activities tailored to the patient. The American Physical Therapy Association states that work hardening improves: • Strength • Endurance • Movement • Flexibility • Motor control • Cardiopulmonary capacity ...related to the performance of work tasks.

8. Work Hardening • Work hardening programs may include services from several specialties. Work hardening programs may include a: • Rehabilitation specialist • Treating physician • Psychologist • Vocational rehabilitation specialist

9. There are several things you should be aware of when reviewing charges for work hardening. Work Hardening 1. Physical therapy provided in combination with the work hardening program, such as a “warm-up” or “cool-down,” is considered part of the program and is not separately reimbursable. 2. Work hardening is reimbursed according to time increments. All services performed within a specific length of time are included in the charge, and should not be reimbursed separately. 3. Work hardening programs typically last for more than a few hours.

10. Work Hardening • Many physical therapy groups bill for work hardening when performing a lot of varied procedures and modalities, not an actual program. How might you identify whether physical therapy charges were for work hardening program? That’s right! You can verify this information by reading the documentation.

11. Acupuncture Acupuncture services are subject to guidelines as well... Let’s take a look…

12. Acupuncture involves the stimulation of specific points on or near the surface of the body in order to treat a patient for pain, as well as diseases and disorders of the body. Acupuncture Acupuncture codes include: • CPT 97810: without electrical stimulation – initial 15 minutes • CPT 97811: without electrical stimulation – each additional 15 minutes • CPT 97813: with electrical stimulation - initial 15 minutes • CPT 97814: with electrical stimulation – each additional 15 minutes Acupuncture codes = 15 minute increments

13. There are a few guidelines that you should be familiar with when reviewing charges for acupuncture services: Acupuncture Time = Face to face time, not the time needles are in place. Only 1 initial code may be billed per visit. All additional time coded with 97811 or 97814. Office visits are included with acupuncture unless modifier 25 is attached. Documentation must show significant, separately identifiable E/M services performed.

14. Osteopathic Manipulation Lastly, we will discuss osteopathic and chiropractic manipulation services... • Osteopathic Manipulation • Chiropractic Manipulation

15. Osteopathic manipulation focuses on correcting body mechanics and structural abnormalities to treat illness, injury, and disease. Osteopathic Manipulation Osteopathic manipulation codes are: • Limited to Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs). Osteopathic Manipulation codes range from 98925 – 98929. Osteopathic manipulation procedure codes depend on how many body regions are manipulated. Let’s take a look…

16. Head Region Cervical Region Pelvic Region Rib Cage Upper Extremities Thoracic Region Abdomen & Visceral Region Lumbar Region Lower Extremities Sacral Region Osteopathic Manipulation • Body regions include:

17. Chiropractic Manipulation In addition to osteopathic manipulation, there are chiropractic manipulation procedures. Let’s take a look…

18. Chiropractic manipulation focuses on the improvement of joint and neurophysiological function. Chiropractic Manipulation Chiropractic manipulation codes not only depend on the number of body regions manipulated, but whichbody region as well. Chiropractic Manipulation codes range from 98940 – 98943.

19. For CPT 98940 through CPT 98942, regions include:  Cervical Region Thoracic Region Lumbar Region Pelvic Region Sacral Region Chiropractic Manipulation includes atlanto-occipital joint Now let’s take a look at CPT 98943... includes costovertebral and costotransverse joints *Only the most extensive code is allowed to pay.

20. HeadRegion Rib Cage Lower Extremities Upper Extremities Abdomen Chiropractic Manipulation • For CPT 98943, the following regions apply: includes temporomandibular joint excludes atlanto-occipital joint excludes costotransverse joint excludes costovertebral joint

21. Office Visits with Manipulation • If osteopathic or chiropractic manipulation is billed, can E/M also be billed? • Modifier 25 must be attached to the office visit code • Documentation must show significant separately identifiable E/M services were rendered. Yes! Manipulation codes are keyed as billed and automated to pay at 113% of the Medicare fee schedule.

22. How work hardening and acupuncture services are reimbursed. Summary Physical Medicine: General Guidelines Osteopathic and chiropractic services.

23. Unit 1 Quiz Click on the link to go directly to the quiz. Feel free to review any of the material before you move on. Good Luck! Quiz: U1: Professional Services