It is also true that the 97542 wheelchair management and training code
is the only code that can be billed for treatment on the same day the
evaluation code is used. This makes it possible to do the OT eval/
Whelchair assessment on the same day. I procure the doctor's order for
eval and tx ahead of time.
It's all a work in progress on my part because it is a very new field
to be doing only w/c evals in patients' homes but not as part of a
home health agency. Believe me, it confounds all of the funding
sources when I call with ?S.
Sure is fun, though!
Your explanation of the 7 minute rule is what I understood..... but it
needs to be clear that an hour long treatment is 4 units, not 8 units
(as it would be if it were a true "per 7 minute unit").
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 7:00 PM, Ron Carson wrote:
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> --
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