Unit 2-WK6- Diagnosis and Procedural Coding I and II

Question 1

Why is it important for physical therapists to understand how to select the correct codes ?

Answer 1

To demonstrate medical necessity for PT

PTs are also held accountable for their coding; they can be held liable for incorrect billing.

Question 2

ICD-10 ccodes are used to describe Medical and Physical Therapy Treatment diagnoses what is the difference ?

Answer 2

Medical Diagnosis: femur fracture, CVA
medical reason they’re seeing a PT

Physical Therapy/Treatment diagnosis: labeling of PT diagnosis for which the patient will be treated. knee pain muscle stiffness etc.

Question 3

List the benefits of ICD-10 codes.

Answer 3

laterality ( RT v LT)
traumatic or non-traumatic injury
dominant side or non-dominant side
unilateral or b/l
cause of traumatic injury
place of occurrence
activity being performed when illness/injury occurred

Question 4

Describe the anatomy of an ICD-10 code.

Answer 4

Category: the first 3 characters of a code, signifies diagnosis that relates to a chapter, normally used in conjunction with number to specify injury

Etiology, Anatomic site, severity: spaces 3-6, the cause anatomic site, severity, or other vital clinical details

Extension: the 7th character: episode of care

S86.011D

Question 5

How do you determine the first ICD-10 CM code on your eval ?

Answer 5

The first code is the main reason that the patient is receiving therapy, other codes are then detailed for other conditions the patient may have

code can describe symptoms if MD has not diagnosed.

Question 6

Explain the different 7th characters.

Answer 6

A(initial): used for the entire period in which a patient receiving active treatment for the condition

D( subsequent): after the active phase of treatment when the patient is receiving routine care for the condition during ht period of healing or recovery phase of treatment.

S( sequela): complications or conditions that arises as a direct result of the condition

Question 7

What chapter is the 7th character REQUIRED for ?

Answer 7

CH19+15

Question 8

Do all codes have 7th characters ?

Answer 8

no

Question 9

What is the purpose of external clause codes ?

Answer 9

they capture how conditions occured, provide context, function as secondary codes

Question 10

What are the different kinds of external cause codes ?

Answer 10

external cause code, place of occurence, activity, intent, individuals status

Question 11

Is it mandatory to report external cause codes ?

Answer 11

no

Question 12

Do external cause codes apply to all categories of diagnosis codes ?

Answer 12

no

Question 13

Where do you document external cause codes ?

Answer 13

on initial evaluation; not principle diagnosis

Question 14

When should “ aftercare codes” be used ?

Answer 14

first try to find the 7th character code

if there is no other way to express that patient is on the after side of an aforementioned before and after event.

code for underlying conditions

Question 15

For conditions involving multiple sites such as OA, there often is a “ multiple sites” code available. If none is available you should:

Answer 15

list multiple codes to indicate all different sites involved.

Question 16

Acute vs Chronic or reccurent codes are found in what chapters ?

Answer 16

19 includes: acute, traumatic problems

13: includes chronic or recurrent problems.

Question 17

What is the difference between ICD-10 codes and CPT codes ?

Answer 17

CPT= procedure codes, interventions
ICD-10= diagnosis codes

Question 18

When are CPT codes updated by the AMA ?

Answer 18

every jan 1st

Question 19

In outpatient settings CPT codes are used for __________ while in inpatient settings they are used for ____________

Answer 19

billing

productivity, staffing, tracking

Question 20

CPT codes have different values based on:

Answer 20

work expenses
practice expenses
geographical location

Question 21

Compare and contrast service based and time based CPT codes

Answer 21

service based: untimed
bill on unit of code per discipline, per practice, per insurance
does not matter how many different body parts you treat or how long you treat.

Time based: 1 on 1 patient contact
timed in 15 minute increments= 1 unit
can bill multiple units of the same time based CPT code on same day per discipline per patient.

Question 22

What series are the majority of CPT codes forr PT procedures found ?

Answer 22

97000 series

Question 23

Describe what can happen if a PT bills for procedures they did not provide.

Answer 23

audits, fines, litigation, loss of license

Question 24

Compare and contrast supervised modalities vs constant attendance modalities.

Answer 24

supervised- modality that does not require 1 on 1 patient contact ( untimed and service based )

constant attendance- modality that requiress direct 1 on1 patient contact ( time based, minute units)

Question 25

Explain what therapeutic procedures are and how the interventions for it are used.

Answer 25

- direct patient contact; 1 on 1 - requires the PT to maintain direct patient contact during the provision of services

Question 26

What does Therapeutic exercise include ?

Answer 26

strength ROM flexibility endurance functional limitations

Question 27

List examples of documenting skill forr therapeutic exercise.

Answer 27

" PROM flexion and extension to LT knee to prevent joint contracture, 10x10 reps in each direction, monitoring for pain w/ each repetition'

Question 28

Neuromuscular reducation is used when you are providing services to improve:

Answer 28

balance, coordination, kinesthesia, proprioception

Question 29

Gait training is defined as:

Answer 29

direct 1 on 1 contact in performance of directive exercises or activities designed to improve a patient's ability to ambulate safely and efficiently ambulation on level and unlevel surfaces stair training education of use of an assistive device ambulating w/ prosthesis or orthosis ambulation to decrease gait deviations educating a caregiver on how to guard a patient during ambulation

Question 30

Therapeutic activities is defined as:

Answer 30

use of functional/dynamic activities to improve/restore functional performance in a progressive manner. such as: bed mobility transfer training car transfer lifting and carrying pushing and pulling pinching and grasping crawling and climbing throwing and jumping any functional activities

Question 31

Manual therapy techniques is used to:

Answer 31

decrease pain, swelling, and increase joint mobility and ROM such as: joint mobs manipulation manual lymphatic drainage manual traction myofascial release

Question 32

Self/care home management training is used for anything that involves:

Answer 32

anything that involves training the patient how to function in their home such as: ADLs meal prep safety procedures personal hygiene chores and cleaning

Question 33

When instructing a patient in an HEP should you bill the home management code ?

Answer 33

No, it would go under TherEx or NMR

Question 34

Aquatic therapy can be billed:

Answer 34

any activity performed in the water

Question 35

What must be included in the documentation when billing for aquatic therapy ?

Answer 35

why it is reasonable and necessary i.e. why patient cannot tolerate land therapy

Question 36

Community worrk integration training is the codes used anytime you work toward:

Answer 36

re-integrating patient into community such as: shopping transportation money management assistive tech

Question 37

Wheelchair management is used for

Answer 37

assessment, fitting, or training for a wheel chair would include any therapy regarding a wheel chair

Question 38

Work hardening/conditioning is used to address:

Answer 38

specific, work related lifting, pulling, carrying, anything specific to occupational requirement

Question 39

Group therapy involves constant attendance but does not require one on one patient contact. The therapist is working with ____________ while providing skilled therapy.

Answer 39

2 or more patients

Question 40

Is group therapy timed or untimed code ?

Answer 40

untimed

Question 41

LT shoulder PROM into flexion, extension, adduction, and abduction, 3x10 in each direction would be coded as :

Answer 41

Therapeutic Exercise

Question 42

Standing on a wobble board without UE support, focus on ankle reactions and maintaining balance would be coded as:

Answer 42

NME

Question 43

TENS to low back, x15 minutes while therapist documents at desk would be coded as

Answer 43

unattended e-stim

Question 44

transferring in< > out of a car using a walker with CGA and cues for correct sequencing would be coded as

Answer 44

therapeutic activites

Question 45

ambulating in the hallway with a quad can x8 minutes to improve activity tolerance would be coded as

Answer 45

therapeutic exercise

Question 46

sidesteping right and left over small hurdles with 3 lbs ankle weights with focus on increasing hip flexion to clear the hurdle would be coded as

Answer 46

TherEx

Question 47

Sidestepping to right and left over small hurdles with 3 lbs ankle weights with focus on ankle reactions and increasing single leg stance would be coded as

Answer 47

NME

Question 48

PT eval codes reflect the _____, ______ and __________ of PTs in caring their patients/clients.

Answer 48

expertise, skill, and responsibility

Question 49

Are PT evals and re-evals codes timed or untimed ?

Answer 49

untimed

Question 50

The PT eval codes reflect 3 levels of patient presentation:

Answer 50

low moderate complex

Question 51

The components used to determine which eval code to use:

Answer 51

patient Hx examination clinical presentation

Question 52

Explain the low moderate and high categories for patient Hx

Answer 52

low: no personal factors or comorbidities moderate: 1-2 personal factors or comorbidities high: 3+ personal factors or comorbidities

Question 53

Explain the low moderate and high categories for the examination of eval codes.

Answer 53

low: 1-2 areas assessed moderate: 3+ areas assessed high: 4+ areas assessed

Question 54

Explain the clinical presentation low moderate and high categories:

Answer 54

low: no complicating factors moderate: evolving condition high: unstable condition

Question 55

Should time be used when determining eval codes ?

Answer 55

no

Question 56

Describe how you determine which eval code to bill for after completing a patient evalutation.

Answer 56

low to high in each category then choose the lowest one

Question 57

Describe the re-evaluation of an established POC CPT code.

Answer 57

an exam that includes a Hx review and use of standardized test and measures a revised POC using a standardized patient assessment instrument.

Question 58

When is it appropriate to bill for a re-evaluation ?

Answer 58

a. improvement or decline, or change in pts condition not anticipated b. new clinical findings during Tx c. the patient fails to respond to Tx in POC d. if state practice act requires it e. treating a chronic condition