Reporting Physical and Occupational Therapy Services

Conference Material (Password Required)

Physical and Occupational Therapy services are performed in several different places of service but the coding is the same as codes are chosen by time and modifiers are used to identify the type of treatment and could also report the providers involved in the treatment. Different insurance carriers use several methods of calculating the time as most codes are reported based on 15-minute increments. Therapists and/or assistants perform the services and in 2022 the rules on how to report services in these circumstances have changed. Services performed by assistants must be recognized for proper reimbursement. These guidelines were created by Medicare and implemented by several insurance carriers other than Medicare. Patients can also have coverage limits on therapy so tracking of visits is critical for the therapy practice. Documentation of these services can be complex as the types of services performed, the provider of the service and the time spent on each modality has to be recorded as well as the plan of care designed by the therapist during the first visit which includes an evaluation of the patient and what is needed to treat the patient.

Learning Objective:

• Understanding the documentation for therapy services
• Maximize reimbursement by applying the different methods of calculating time
• Review examples of when a therapy assistant is involved and what is necessary for billing
• The use of modifiers and when they should be applied for clean claims
• Confirm what documentation is necessary for therapy services

Areas Covered in the Session:

• Order requirements for therapy
• Documentation for a Plan of Care
• Assignment of codes by therapeutic treatment and time
• Assistant involvement and modifier requirements
• CMS thresholds and how to report services when the thresholds have been met
• Reporting service incidents to
• When can supplies be reported?
• CMS NCCI Policy Manual Instructions

Suggested Attendees:

• Billers
• Coders
• Administrators
• Managers
• Physicians
• Claims Adjusters
• Surgery Schedulers
• Caseworkers
• Nurses
• Reimbursement Staff

About the Presenter

Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.