Week 3 Flashcards
(22 cards)
A patient evaluation document is an essential document for establishing medical necessity and demonstrating skilled care. What are the elements of an evaluation?
• Name and Diagnoses- Rehab & Medical
• Reason for Referral
• Medical/Therapy History
• Prior Level of Function PLOF!!!
• Functional Limitations – Objective Testing with Context!!
• Corresponding G-codes
• Objective Data of Impairments including pain if it is affecting Function
• Measurable Goals with a Time Frame
• Reasonable Plan with Interventions, Frequency,
Duration, Rehab Potential (use CPT codes/numbers)
What are some of the typical areas of improvement in an evaluation?
• Many Work Comp evaluations don’t include physical requirements of job & corresponding RTW goals.
• When clinical conclusions are made on the evaluation- they should be substantiated with testing reported in the exam.
• Sports specific deficits & goals must be supported with daily functional deficits & goals in order to assure payment by 3rd party.
• Evidence of a Signed POC should be easily discernable on audit.
• Consistent Use of functional measurable testing @ Evaluation, Progress reporting intervals & DC is preferred especially for MC/MA. would be a definite asset to billing & coding. G-codes with severity modifiers must not only be put into the billing but their selection must be documented
in the Evaluation, Progress Reports, DC Summaries.
• Measurable functional goals are often set in a POC that may not have an associated baseline.
• There are often an evaluations where treatment is provided, including instruction on HEP, and treatment is not billed
What are the elements of a plan of care (POC)?
• Signature and credentials of the therapist or physician/NPP
completing the initial evaluation and plan of care.
• Legibility Concerns!
• Each therapy discipline must have a separate plan of care.
What is information is the minimum information required to be on a POC?
- Diagnoses
- Long term treatment goals
- Type, amount, duration and frequency of therapy services.
What are the other types of information that can be included on a POC?
• The interval dates for which the certification applies;
• Signature, date & professional identity of the person who
established the plan;
• Dated Physician/Non-Physician Practitioner signature.
How often is a POC progress report required for patients under medicare?
At least every 10th visit, with the exception of when a PTA supervision which might require more frequent reports
What are the purposes of a PN?
• Update Existing Goal(s)
• Update G-coding/severity modifiers with rationale- repeat
tests
• List New Goal(s)
• List ongoing & new interventions
• Comment on interventions which have been eliminated
and why.
• Update frequency, duration or visit number.
• Discuss new goals, strategies, interventions.
What are some more reasons why we write a POC progress report?
- Progress Reporting @ proper intervals that re-measures Functional Status
- Demonstrates Measurable Progress! Reports updated G-Code Severities on the claim & in the documentation.
- Re-affirms measurable deficits
- Demonstrates measurable change in related impairments
- Synthesizes key information & demonstrates skill
- Describes a Plan that requires ongoing skilled care
- Describes client carry-over such as HEP, Use of function and impact on QOL
What are the typical areas of improvements for a POC?
• POCs are often not updated on progress reports. That is appropriate when the patient is making expected progress toward goals but NOT if patient is making minimal or no progress.
• In the case of lack of progression the Progress Note/POC should reflect clinical decision making such as: is there a reason for lack of
progress-illness? Other? OR Are new Goals? Interventions needed? OR a return to MD? Or DC?
• On some Progress Reports there is mention that goals are “in progress”, but there should actually be a measurement of progress reported
What are the elements of billing and daily documentation?
• Recording Date, POS
• MINIMUM Requirements including: timed code treatment minutes, total treatment time in minutes, and signature and professional identification of the qualified professional who
furnished the services
• Outcome/Assessment: Subjective- include family discussions here
• Client Focused response to Interventions
• Utilize a distinct statement for each billing code (Medicaid)
• Charge as you document interventions- indicate code abbreviation next to your statements
• Don’t forget: Carry-Over, Continue or Modify Plan
• Don’t forget to document Home Programs
• Signature/Credential
What are the typical areas of development in billing and daily documentation?
• Having a limited repertoire of Billing Codes and progression to more function. For Example: TE>NMR>TA>ADLS are rarely seen.
• Preference for Passive Versus Active Code Billing.
• With repeated visits especially lengthy treatment plans skilled care and a should be evident.
• Many clinicians would benefit from additional education on code
selection in the face of multiple timed codes.
• There were a few situations where part of the daily note appeared to have been cloned. Never copy forward subjective or assessment statements.
What is the information expected to be on a discharge note?
- Each Episode of Care
- Summary of Episode in Progress report Format
- Final Justification of Medical Necessity- Update G-codes
- Updated HEP!!!
- Parting recommendations/Follow up instructions
What are some reasons for an unexpected DC?
- Patient
- MD/Chiro
- Payer.
A discharge note is still expected
What is Resource-Based Relative Value Scale (RBRVS)?
Payment for services varies with resources & costs associated with delivery. Every billing code has this.
What factors does the Resource-Based Relative Value Scale (RBRVS) capture?
Provider work (Time, skill & effort, Mental Effort & Judgment, Stress of risk) x Practice expense x Professional Liability
What is Multiple production payment return (MPPR)?
When only one unit of is paid in full for a therapy session by insurance, and the rest is paid in partial.
What are the only codes proprietary to PT?
97001- PT eval
90772- PT re-eval
What is the hierarchy exercise codes?
- There Ex
- Neuromuscular Re-ed
- Therapeutic Activities
- ADLs
- GT
What are the components that constitutes a timed code?
• Time spent in formal/informal assessment of related fxn/
impairments
• Time spent educating client/caregiver related to intervention with the client present
• Time spent in face-face intervention
What is the code for manual therapy and what is its value?
- Valued at 0.82
How long is a typical PT timed code?
15 mins
How do we aim for consistent presence and participation of our patients?
- Therapist dialogue & patient buy-in on importance of the POC
- Schedule out the POC
- Have a consistent CX/NS policy
- Communicate concern about CX/NS
- Script the scheduler on “call-ins”
