MMT and ROM CPT codes (Full Version)

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ptdan23 -> MMT and ROM CPT codes (November 23, 2007 2:19:58 PM)

Can anyone give me some guidance regarding use of the MMT (95831) & ROM (95851) CPT codes?  There is some debate in some facilities regarding their use. 
Thanks, Dan.




FLAOrthoPT -> RE: MMT and ROM CPT codes (November 23, 2007 2:48:44 PM)

I am pretty sure you can only use that for like worker's comp if the insurance company requests you give them some updated readings etc, but even then, I'd just use a re'eval code, don't think they are really used.  But would love to hear other people's opinions.




jma -> RE: MMT and ROM CPT codes (November 25, 2007 4:38:41 PM)

In some outpatient settings, the 97002 (re-eval code) is used but rarely.




buckeye -> RE: MMT and ROM CPT codes (November 26, 2007 2:13:22 PM)

Most of the time, PT and OT will probably be better off using the  97xxx codes for billing because they are designed primarily for the therapies. Other codes may be an invitation for a review of the bill.

I recall the 97002 code for re-evaluation cannot be billed with other common procedures. So if you are truly seeing the patient for re-evaluation and that is the sole purpose of the visit, it seems like the most appropriate code. However, if the patient is seen briefly (the 97002 is not a timed code) and then receiving treatment, it may be wiser to bill for the treatment procedures and modalities.





orthotherapist -> RE: MMT and ROM CPT codes (November 26, 2007 3:49:58 PM)

My company hired an outside consultant to review charges, compliance, etc.  They informed us that those codes can be used and will not flag an audit as long as documentation supports the use of them.  They gave an example of a patient that is returning to their MD - you as the therapist do a full reassessment with a report (i.e. post op shoulder) indicating new ROM and/or strength.  The appropraite code to bill would be one of the ones you mention not the reeval code.  The reeval code is strictly for a reeval after a change in status and frequent use of this code may trigger an audit.

Just what we were told by an nationally recognized firm




buckeye -> RE: MMT and ROM CPT codes (November 26, 2007 9:39:55 PM)

I respect your answer - I have not talked to anyone specifically about these codes recently. The 95831 and 95851 codes do not have many code edits compared to 97002. It is my understanding there should have an accompanying written report for 95831 and 95851. Is that correct?

I agree the 97002 code used frequently is not ideal.




orthotherapist -> RE: MMT and ROM CPT codes (November 26, 2007 10:23:14 PM)

yes there must be a report generated (from my understanding)




SJBird55 -> RE: MMT and ROM CPT codes (November 27, 2007 1:00:08 AM)

I use the 97002 frequently... every 30 days OR whenever there is a change in presentation OR if it appears the patient could be discharged sooner than anticipated.  A modifier is used when the 97002 is combined with any therapeutic interventions.  I haven't been audited nor have I not been reimbursed (generally).  The General Motor (automotive world) policies do not pay for 97002 no matter when it is used.  I tend to believe that if I'm using my clinical skills to make a decision because 1) some insurance company has placed a 30 day requirement onto me, I'm gonna get paid and 2) if there is a change in condition, then I should be paid for my skill in re-evaluating and reassessing the condition or complaint. 

I don't use the MMT or the ROM codes.  1)  from an orthopaedic perspective - for example a post-op situation, how long does it take to measure ROM or do a MMT?  What we do is so much more than just ROM measurements or MMT.  There are usually a lot more variables that I have within my focus that need to change, so I prefer a 97002.  Now... I do recall a patient that I was working with last year who had spina bifida... I charged a 97002, but I probably could have used the MMT codes because I had LOTS of measurements I was taking and assessing - all 4 extremities and charting change to assist with determining his tolerance and response to physical therapy.  But hardly do I actually have a ton of MMT or ROM measurements for most patients.  His report was a pain in the butt to generate.




ptdan23 -> RE: MMT and ROM CPT codes (November 29, 2007 8:36:55 PM)

quote:

ORIGINAL: SJBird55

I use the 97002 frequently... every 30 days OR whenever there is a change in presentation OR if it appears the patient could be discharged sooner than anticipated.  A modifier is used when the 97002 is combined with any therapeutic interventions.  I haven't been audited nor have I not been reimbursed (generally).  The General Motor (automotive world) policies do not pay for 97002 no matter when it is used.  I tend to believe that if I'm using my clinical skills to make a decision because 1) some insurance company has placed a 30 day requirement onto me, I'm gonna get paid and 2) if there is a change in condition, then I should be paid for my skill in re-evaluating and reassessing the condition or complaint. 

I don't use the MMT or the ROM codes.  1)  from an orthopaedic perspective - for example a post-op situation, how long does it take to measure ROM or do a MMT?  What we do is so much more than just ROM measurements or MMT.  There are usually a lot more variables that I have within my focus that need to change, so I prefer a 97002.  Now... I do recall a patient that I was working with last year who had spina bifida... I charged a 97002, but I probably could have used the MMT codes because I had LOTS of measurements I was taking and assessing - all 4 extremities and charting change to assist with determining his tolerance and response to physical therapy.  But hardly do I actually have a ton of MMT or ROM measurements for most patients.  His report was a pain in the butt to generate.


SJ - thank you (and everyone else) for their response.  I am glad that someone else said what I was thinking and the interpretation in the use of the codes that I mentioned.  I use the Re-eval code when appropriate but I have only used the ROM/MMT codes maybe 1-2x in my 6 yr career where I had to take a significant number of measurements.  My regional manager has told the facilities under him that the ROM/MMT codes should be used whenever to take a measurement.  Now, if something takes me 30 seconds to measure I am not going to bill that code.  If it will take a significant amount of time I would consider it but even in that case it would most likely be a re-evaluation if the patient is returning to the MD, etc.
Would love to hear any other input.
Dan




orthotherapist -> RE: MMT and ROM CPT codes (November 29, 2007 8:59:44 PM)

I think this is a case of chasing shrinking reimbursement.  Untimed code - does not take long to do - we do it anyway so lets charge for it since it will be reimbursed type of thing.  Can now technically/legally bill three units for medicare in 30 minutes.  I agree with the above.  When the consultant told us this you could hear the moans - must be the new thing if your regional manager is also saying it.




jlharris -> RE: MMT and ROM CPT codes (November 29, 2007 9:22:10 PM)

Why not bill for what you do?  Should it matter that it only took 30 seconds?  My peditrician billed me not only for the vaccines administered to my little guy, but also for the nurse physically giving them.  At $30 a pop (and he got 5).  If you don't think it's worth billing for, it's not skilled.  And if it's not skilled then why are we, as a skilled profession, doing it?

Purposely polarizing the issue, by the way.




ptdan23 -> RE: MMT and ROM CPT codes (November 29, 2007 9:38:36 PM)

quote:

ORIGINAL: jlharris

Why not bill for what you do?  Should it matter that it only took 30 seconds?  My peditrician billed me not only for the vaccines administered to my little guy, but also for the nurse physically giving them.  At $30 a pop (and he got 5).  If you don't think it's worth billing for, it's not skilled.  And if it's not skilled then why are we, as a skilled profession, doing it?

Purposely polarizing the issue, by the way.


Hi Jason,
I totally agree that we should get paid for what we do.  Lets use an example - s/p ACL recon - seeing pt 3x/wk.  Lets say I take a knee flex/ext measurement every tx.  Should I bill the ROM code every time?  Yes, you could I guess but I usually integrate that into my tx.  Lets say I was performing some manual tx and then took a measurement to assess progress after performance of the technique - I would just integrate that into the manual therapy code.  Now if I took comprehensive measurements to write a report for work comp or MD and I wasn't going to bill a re-eval code then I think I would be more likely to use the ROM and/or MMT code. 
Dan




jlharris -> RE: MMT and ROM CPT codes (November 30, 2007 12:17:59 AM)

quote:

ORIGINAL: ptdan23

Hi Jason,
I totally agree that we should get paid for what we do.  Lets use an example - s/p ACL recon - seeing pt 3x/wk.  Lets say I take a knee flex/ext measurement every tx.  Should I bill the ROM code every time?  Yes, you could I guess but I usually integrate that into my tx.  Lets say I was performing some manual tx and then took a measurement to assess progress after performance of the technique - I would just integrate that into the manual therapy code.  Now if I took comprehensive measurements to write a report for work comp or MD and I wasn't going to bill a re-eval code then I think I would be more likely to use the ROM and/or MMT code. 
Dan


Totally agree with you.  Question for everyone:  When would you take ROM and/or MMT measurements and not make and assessment and plan with those?  And if you did use your expert knowlegde by formulating an assessment and plan then why charge ROM/MMT and not Re-eval?

I have honestly never used the ROM/MMT CPT codes, nor have worked with/mentored by anyone who has.  So I could be very mistaken in it's use - or - in my non - use.




SJBird55 -> RE: MMT and ROM CPT codes (November 30, 2007 12:21:09 AM)

Yeah, but Dan... when you write a report for worker compensation or a physician for a person with a s/p ACL reconstruction, there is so much more information than just ROM or MMT that you need to be conveying.  Let's see.... edema, skin/incision, gait, weightbearing status, quality of gait, balance/proprioception, function, pain, maybe some hop tests.... and then, you are taking that data and looking at progress... and then assessing the changes that have occurred and looking at the plan of care and goals and making adjustments as needed.  Is the patient on target?  Is something else required?  Is return to work a goal - will restrictions be necessary?  Is bracing required?  A surgeon on a recheck visit can assess the available motion and strength of the patient in oh... 1 - 2 minutes, probably.  In my opinion, a re-evaluation code is very appropriate.




ptdan23 -> RE: MMT and ROM CPT codes (November 30, 2007 8:43:19 PM)

quote:

ORIGINAL: SJBird55

Yeah, but Dan... when you write a report for worker compensation or a physician for a person with a s/p ACL reconstruction, there is so much more information than just ROM or MMT that you need to be conveying.  Let's see.... edema, skin/incision, gait, weightbearing status, quality of gait, balance/proprioception, function, pain, maybe some hop tests.... and then, you are taking that data and looking at progress... and then assessing the changes that have occurred and looking at the plan of care and goals and making adjustments as needed.  Is the patient on target?  Is something else required?  Is return to work a goal - will restrictions be necessary?  Is bracing required?  A surgeon on a recheck visit can assess the available motion and strength of the patient in oh... 1 - 2 minutes, probably.  In my opinion, a re-evaluation code is very appropriate.


SJ and Jason -
I agree with both of you.  I think in most cases a re-eval code would be more appropriate to use.  That was one of my main reasons for this post in the first place.  I was confused by my regional mgr reason for use of this code.  Sounds like as previously mentioned it is a financial way to add another charge to a visit.  I have not used it nor will I give into his pressure unless I feel it is appropriate. 
Thanks, Dan.




Kaden -> RE: MMT and ROM CPT codes (November 30, 2007 8:58:10 PM)

ptdan,

I agree with others in this post that a re-eval code is more appropriate.  The MMT and ROM codes are reactions by companies/clinics to capture the loss of revenue from continually declining reimbursment.  On one hand I can't blame them as they need to stay viable but to come up with creative ideas like this to increase revenue isn't getting at the root of the problem.  We as PTs and the APTA need to continue to fight reimbursment head on, not find creative ways around it and that is hopefully the only way things will change.  Ultimately, I think companies promoting, IMO what is "sketchy ethics", with billing practices, it hurts those billing honestly for what we do.




PTupdate.com -> RE: MMT and ROM CPT codes (December 1, 2007 3:53:30 AM)

Some points to consider:

For those who prefer to use the 97530 code when treating (functional activities/tasks), then the ROM/MMT cannot be billed as per CCI edits, nor can the ,59 modifier be used, so it becomes a moot point

With regards to Medicare, I am under the belief that re-eval (97002) should not be billed unless a new diagnosis has been entered, or there has been some drastic change or development.  Otherwise, Medicare considers the "re-eval" something that should be done on an ongoing basis anyway

When doing a re-eval, many criteria need to be filled, including addressing all the original goals and how you have progressed towards those, rationale for skilled care, expected outcomes, functional deficits, time frames, new goals, etc.  Sometimes the ROM and MMT with their seperate report in the chart are all that is needed (say, a RC repair patient still in the PROM phase).

So, if we do something on a patient, and there is a code that can be billed for that treatment, why not?  Besides Medicare with the stupid 8 minute rule, why does something that is beneficial for the patient have to be a time consuming process?  Will MD's get hit with this rule, and leave the syringe sticking in my ass for 8 minutes to get paid for the injection?  If a manipulative technique is what a patient needs, should it matter if it took me 8 seconds or 8 minutes?




buckeye -> RE: MMT and ROM CPT codes (December 3, 2007 3:35:43 PM)

As a clarification on my comment of not using 97002 frequently - I guess 'frequently' is a relative term. To use it on a patient every 30 days would not be uncommon. I was thinking in terms of likely not using it weekly on a given patient. The comments and ideas in this thread are great.




PTupdate.com -> RE: MMT and ROM CPT codes (December 3, 2007 4:50:09 PM)

Or, if the payor demands otherwise.  Some give you 6 visits, and to get more, they want all kinds of info, which basically constitutes a re-eval (ROM, strength, goals, progress, DASH or Lysholm scores, etc).  In that case, if they want the info, they can pay for it via 97002




pappawheelie -> RE: MMT and ROM CPT codes (December 3, 2007 6:08:57 PM)

quote:

Will MD's get hit with this rule, and leave the syringe sticking in my ass for 8 minutes to get paid for the injection? 


Hilarious.  What burns my bottom is that the 8-minute rule essentially defines ethical practice by a physical therapist.  Shouldn't we be the ones who determine how long it will take to provide skilled interventions? 




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