Hello Mary: The 7 minute rule is this:
1 unit= greater than 8 minutes bus less than 23 minutes 2 units = greater than 23 minutes but less than 38 minutes 3 units = greater than 38 minutes but less than 53 minutes 4 units = greater than 53 minutes but less than 68 minutes etc.... In general, there are two different types of w/c evals: 1. One time evals to determine medical necessity 2. Eval and ongoing treatment for high-level needs For one-time evals, I recommend the w/c assessment code. For the ongoing needs of high-tech seating, I can see that an OT eval generating a plan of treatment that is signed by an MD is indicated. However, the plan of treatment should be generated prior to beginning treatment. In general Medicare will only purchase new equipment if there is a significant change in the patient's status. Thanks, Ron ~~~ Ron Carson MHS, OT www.OTnow.com ----- Original Message ----- From: Mary Alice Cafiero <[email protected]> Sent: Thursday, June 11, 2009 To: [email protected] <[email protected]> Subj: [OTlist] W/C evals MAC> Ron, MAC> I am curious to know where you got the "per 7 minutes" for unit time MAC> on the CPT codes. The manuals I have seen all say that it is "per 15 MAC> minutes". That would make a huge difference in reimbursement as I am MAC> doing almost all complex evaluations. MAC> Also, I do charge for an OT evaluation and consider the first 20 to 30 MAC> minutes of my time with the patient the "OT eval" where we determine MAC> overall status and goals. If the goal is to pursue a mobility device, MAC> then the w/c eval starts and is actually the completion of the plan of MAC> care unless future sessions are needed for seating or training needs. MAC> Since I don't see patients for ongoing care, this seems to make the MAC> most sense. I would do it differently if I were a home health MAC> therapist and this was just one or two of my sessions. MAC> There is also an "Assistive Technology" code that you can use for MAC> things like power training, teaching at delivery, etc. I forgot the MAC> CPT number, but it is an OT/PT code that is billed per unit. MAC> Just as a word of caution from someone who does this all day every MAC> day, please be aware of all the Medicare changes and rules if you are MAC> recommending mobility equipment for your patients. The documentation MAC> requirements are extensive. It is almost impossible to get Medicare to MAC> pay for anything new for five years, so be sure that you know the MAC> equipment you are recommending is the most appropriate match for the MAC> patient now and for the predictable future. Know that suppliers are MAC> now required to have an ATP on staff that needs to be involved with MAC> equipment selection on every client requiring a Group 2 chair with MAC> multiple power options or any Group 3 chair and above. MAC> Have a good day, all! MAC> Mary Alice MAC> Mary Alice Cafiero, MSOT/L, ATP MAC> [email protected] MAC> 972-757-3733 MAC> Fax 888-708-8683 MAC> This message, including any attachments, may include confidential, MAC> privileged and/or inside information. Any distribution or use of this MAC> communication by anyone other than the intended recipient(s) is MAC> strictly prohibited and may be unlawful. If you are not the recipient MAC> of this message, please notify the sender and permanently delete the MAC> message from your system. MAC> 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] >>> >>> >>> -- >>> Options? >>> www.otnow.com/mailman/options/otlist_otnow.com >>> >>> Archive? >>> www.mail-archive.com/[email protected] >>> >> -- >> Options? >> www.otnow.com/mailman/options/otlist_otnow.com >> >> Archive? >> www.mail-archive.com/[email protected] MAC> -- MAC> Options? MAC> www.otnow.com/mailman/options/otlist_otnow.com MAC> Archive? MAC> www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
