Ron,
I am curious to know where you got the "per 7 minutes" for unit time
on the CPT codes. The manuals I have seen all say that it is "per 15
minutes". That would make a huge difference in reimbursement as I am
doing almost all complex evaluations.
Also, I do charge for an OT evaluation and consider the first 20 to 30
minutes of my time with the patient the "OT eval" where we determine
overall status and goals. If the goal is to pursue a mobility device,
then the w/c eval starts and is actually the completion of the plan of
care unless future sessions are needed for seating or training needs.
Since I don't see patients for ongoing care, this seems to make the
most sense. I would do it differently if I were a home health
therapist and this was just one or two of my sessions.
There is also an "Assistive Technology" code that you can use for
things like power training, teaching at delivery, etc. I forgot the
CPT number, but it is an OT/PT code that is billed per unit.
Just as a word of caution from someone who does this all day every
day, please be aware of all the Medicare changes and rules if you are
recommending mobility equipment for your patients. The documentation
requirements are extensive. It is almost impossible to get Medicare to
pay for anything new for five years, so be sure that you know the
equipment you are recommending is the most appropriate match for the
patient now and for the predictable future. Know that suppliers are
now required to have an ATP on staff that needs to be involved with
equipment selection on every client requiring a Group 2 chair with
multiple power options or any Group 3 chair and above.
Have a good day, all!
Mary Alice
Mary Alice Cafiero, MSOT/L, ATP
[email protected]
972-757-3733
Fax 888-708-8683
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On Jun 11, 2009, at 7:27 AM, Juan Turcios wrote:
Ron thanks for all the good information you have given me. This
helps a lot.
Juan Turcios
On 6/10/09, Ron Carson <[email protected]> wrote:
Lots of good questions. I'll answer to the best of my ability:
JT> I read somewhere that we needed some type of credentials
At one time, Medicare was going to require that all w/c evals
be
done only by people holding an ATP credential. This never
came
to fruition, so no special credential is currently required.
JT> NMy second question is how do you bill medicare for this?
I bill Medicare under the CPT code 97542 <W/C Management>.
This
is a timed codes so billing in accordance with all time
code
requirements, e.g. 7-minute rule, face to face, etc.
There is no specific time allowed for the eval. Each eval
is
different and requires a different time. Usually, 30 minutes
to
an hour is what is required. Higher level evals take longer!
Do not bill under OT eval, as this is NOT appropriate. An
OT
eval is used to generate a plan of care and you will not
be
doing that.
JT> Do we need a doctors order to do this evaluation?
Medicare does NOT require doctor's orders for any therapy.
The
requirement is that the patient be under the care of a
doctor.
This requirement is met when a doctor signs your w/c
evaluation.
You may obtain an order if desired and/or required by
your
state, but it's NOT required by Medicare. But, the patient
MUST
be under a doctor's care. You will need the MD's information
for
billing purposes.
For the record, I do NOT write a separate letter of justification.
That
information is contained in my evaluation.
Hope this helps.
Ron
~~~
Ron Carson MHS, OT
www.OTnow.com
----- Original Message -----
From: Juan Turcios <[email protected]>
Sent: Wednesday, June 10, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] W/C evals
JT> Hello all, I have more medicare questions for you. Are there any
JT> requirements that we (OT's) must have to perform w/c
evaluations? I
read
JT> somewhere that we needed some type of credentials. When I use
to do the
JT> evals (more than 8yrs ago) I remember that I spent about 45-60
minutes
doing
JT> the measurements and about an hour writing the letter of
justification.
My
JT> second question is how do you bill medicare for this? and what
is the
JT> billable time allotted for these type of evaluations? Do we get
the
hour
JT> only and bill under OT evaluation. Do we need a doctors order
to do
this
JT> evaluation? or we can do the evaluation without the other, but
we need
JT> it for w/c training? Thanks again Juan Turcios
JT> --
JT> Options?
JT> www.otnow.com/mailman/options/otlist_otnow.com
JT> Archive?
JT> www.mail-archive.com/[email protected]
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