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40 Cards in this Set
- Front
- Back
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Who makes up the CPT codes?
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American Medical Association (AMA)
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What is a CPT code?
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• Current Procedural Terminology.
• A # that describes an intervention i.e. 97001 - PT eval. • Accurate descriptive terms for reporting purposes. • Provides uniform language. • Allows for reliable nationwide communication |
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Whos uses CPT codes?
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Anyone providing some kind of healthcare.
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How are CPT codes used?
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1. To report MD/DO and other medical providers services under public/private health insurance programs. 2. Claims processing. 3. To develop guidelines for medical care review – ensures consistency. 4. Medical education & research
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Who are the members of HCPAC (HC professionals advisory committee)?
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PT, OT, Speech, PA, RN, podiatry, chiropractic, clinical social worker, optometry and psychology
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CPT options include…
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additions, deletions and editorial revisions/modifications
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CPT process involves….
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code description, clinical vignette (case scenerio), applicable dx, rationale, supportibve research documentattion & related code deletions
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What is RBRVS?
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Resource Based Relative Value Scale. RBRVS attaches a dollar amount CPT codes. Ranked according to value ie brain surgery (high rank), trimming toenails (low rank).
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What is the cornerstone of Medicare's physician/provider payment system?
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RBRVS
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T or F? More than 77% of providers/insurance co. use the RBRVS or its equivalent.
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TRUE
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Formula for Payment Services
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Payment for services = established RELATIVE VALUE x MONETARY CONVERSION FACTOR (changes annually)
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What are the components of Relative Value?
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Physician/provider work (54%), practice expense (41%), Professional liability (how risky the intervention - 5%), Insurance costs C
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What are the components of Physician/provider WORK?
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TIME to perform service, TECHNICAL SKILL & physical effort, mental effort & judgement - SKILL, & STRESS assoc. w/ concern for risk to the pt.
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What are the components of PRACTICE EXPENSE?
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administrative labor, clinical labor, medical supplies & equipment, & supplies
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What is the providers role in working with payers?
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knowledge of current CPT codes, RBRVS & guidelines for documentation of rehab services & providing resources to help them with their work
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What are the CPT codes for physical medicine and rehab?
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97000 series
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What are the CPT codes for evaluations?
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97001 PT Eval
97002 PT Re-Eval 97003 OT Eval 97004 OT Re-Eval |
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Def: Modalities
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any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical or electrical energy
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Def: Supervised
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the application of the modality that does NOT require direct (one-on-one) pt. contact by the provider
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What are the CPT codes for modalities (supervised)?
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97010 Application of a modality to 1+ areas: hot/cold packs
97012 Mechanical Traction 97014 E-stim 97016 Vasopneumatic device (compression device) 97018 Paraffin bath 97020 Microwave 97022 Whirlpool 97024 Diathermy 97026 Infrared 97028 Ultraviolet |
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Def: Constant Attendance
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the application of a modality that REQUIRES DIRECT (one-on-one) pt contact by the provider
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What are the CPT codes for modalities (constant attendance)?
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97032 Application of modality to 1+ areas; e-stim (manual), each 15 min.
97033 Iontophoresis, each 15 min. 97034 Contrast baths, each 15 min. 97035 Ultrasound, each 15 min. 97036 Hubbard tank, each 15 min. 97039 Unlisted modality (specify type & time if constant attendance i.e. anodyne) |
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Def: Therapeutic procedures
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a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. Requires direct pt contact.
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What are the CPT codes for therapeutic procedures?
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97110 Therapeutic procedure, 1 or more areas, each 15 min., therapeutic exercises to develop str, endurance, ROM & flexibility thru 97546.
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What is CPT code 97112?
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Neuromuscular ReED of mvmt, balance, coordination, kinesthetic sense, posture and proprioception.
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What is CPT code 97113?
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Aquatic therapy w/ ther-ex
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What is CPT code 97140?
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Manual Therapy techniques (mobs/manips/manual traction), one or more regions, each 15 min.
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What is CPT code 97150?
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Therapeutic procedure(s), group (2 or more individuals).
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What is CPT code 97530?
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Therapeutic activities, direct pt contact by the provider (use dynamic activities to improve functional performance), each 15 min.
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What is CPT code 97535?
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Self care/home management training (ADL & compensatory training, safety procedures & use of adaptive equipment), direct one-on-one contact by provider, each 15 min.
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What does GROUP THERAPY involve?
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It involves constant attendance but by definition does NOT require one-on-one pt contact by the physician or therapist
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What is the CPT code 97537?
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Community/Work reintegration training(shopping, money management, work task analysis), direct one-on-one contact by provider, each 15 min.
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What is the CPT code 97542?
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Wheelchair management/propulsion, each 15 min.
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What is the CPT code 97545?
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Work hardening/conditioning; initial 2 hours.
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What is the CPT code 97546?
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each additl. HOUR
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Does the AMA support the use of CPT by all 3rd party payors and urges them to implement yearly changes to CPT on a timely basis?
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Yes
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Payment policy challenges:
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Providers bill a SINGLE (15 min.) UNIT for tx >= 8 min. and <23 min., 2 UNITS: 23 min. to <38 min.
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What is the advice by the HCFA memo AB 0039 regarding payment policy challenges?
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To record beginning and ending time in the pt.'s medical record along with a note describing treatment.
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T or F? A modifier is used to describe service provided for less than 8 minutes.
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TRUE
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T or F? A bundled service is not recognized for separate and distinct payment by the Medicare Fee Schedule.
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TRUE
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