I don't have the actual reference close at hand. This was something I
learned at a course when I first started billing on my own. The course
was done by either Permobil or Pride. If you look at the list of CPT
codes that are applicable to OT, it shows the code, the definition,
and what it can be billed with, can't be billed with, and is suspect
if it is billed with. I will do my best to find it later. I do know
that it works to bill both on the same day as that is how I am getting
reimbursed. That is Medicare. Private insurance and Medicaid are a
totally different ballgame and vary wildly.
Juan-- If I saw a patient for only an hour (never happens), I would
bill the eval code and then 2 or 3 units of 97542, depending on how
much time I felt was dedicated to chair discussion/decisions only.
Just FYI, the Medicare evaluation I use is 12 pages long and includes
a place to justify everything that is not an included item in the base
price of the chair. Most Medicare evals take a minimum of 1 1/2 hours
and as long as 3, depending on the complexity and circumstances. I
also use my eval only and don't do an additional LMN.
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 7:53 PM, Ron Carson wrote:
Good conversation.
Mary, will you provide a reference for this statement:
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 MAC evaluation code is used. <<
----- Original Message -----
From: Mary Alice Cafiero <[email protected]>
Sent: Thursday, June 11, 2009
To: [email protected] <[email protected]>
Subj: [OTlist] W/C evals
MAC> It is also true that the 97542 wheelchair management and
training code
MAC> is the only code that can be billed for treatment on the same
day the
MAC> evaluation code is used. This makes it possible to do the OT
eval/
MAC> Whelchair assessment on the same day. I procure the doctor's
order for
MAC> eval and tx ahead of time.
MAC> It's all a work in progress on my part because it is a very new
field
MAC> to be doing only w/c evals in patients' homes but not as part
of a
MAC> home health agency. Believe me, it confounds all of the funding
MAC> sources when I call with ?S.
MAC> Sure is fun, though!
MAC> Your explanation of the 7 minute rule is what I understood.....
but it
MAC> needs to be clear that an hour long treatment is 4 units, not 8
units
MAC> (as it would be if it were a true "per 7 minute unit").
MAC> Mary Alice
MAC> Mary Alice Cafiero, MSOT/L, ATP
MAC> [email protected]
MAC> 972-757-3733
MAC> Fax 888-708-8683
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