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coding anodyne

 
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coding anodyne - December 29, 2004 4:31:00 PM   
FLOrthoPT

 

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I have a company that wants me to "Do some sort of exercise" with a patient while they are on anodyne. Whether or not I believ in anodyne is not what I want to discuss here.

I am under the impression that if they are being billed for this modality then you cannot bill for anything else (mutually exclusive billing). For example, a patient comes in you strap russian stim to his VMO and have him do SLR with the stim. You cannot bill both NMre-ed and e-stim, or not therex and etsim, etc. You can bill for only one code during this time.

Well, since anodyne barely reimburses they want to not bill for it, just bill for the exercise they are doing while they are on anodyne. Well, I was under the impression you had to bill for everything you documented you did. Now I was a clinic director and know the reality or should I say grayness of that last statement, but in black and white, don't you have to bill for everything you do?

SO my question is this: if you are doing stim or anodyne or some unattended moadality, isn't that time spent NOT to have another code being billed during it?

IF anyone knows what I am trying to ask and has the answer I'd appreciate it...
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Re: coding anodyne - December 29, 2004 6:17:00 PM   
SJBird55

 

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I'm not sure what you are asking.

You should document procedures performed during physical therapy treatment sessions. You are not required to bill for every service provided - especially in regard to Medicare. The main example that comes to my mind is hot packs. Hot packs are considered a bundled service - you document that the hot pack was performed but you don't bill for it. Well, I guess you can, but the procedure will not be paid by Medicare.

(in reply to FLOrthoPT)
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Re: coding anodyne - December 29, 2004 6:52:00 PM   
FLOrthoPT

 

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Thanks sj...not what I was looking for though.this answer you just gave is the same I would give, but if I read the codes correctly you SHOULD bill for everything, even knowing that you will not get reimbursed for it. As far as I know you cannot selectively waive charges or co-pays especially for medicare pts. This is precisely part of my question, so I was hoping someone who actually KNOWS the answer and doesn't just have anecdotal evidence can help out here. Thanks for your help though

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Re: coding anodyne - December 29, 2004 7:08:00 PM   
FLOrthoPT

 

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hey after rereading my second post it seems abrasive, didn't mean to be. What I want to know is precisely what you asked too, can you choose to waive random charges just because medicare doesn't pay well for it. That is, can you selectively and arbitrarilly waive any charges, or does EVERY documented thing need to be charged for regardless of whether or not you are going to get paid for it.

That is my question. Specifically, lets hypothetically say you have an anodyne patient who needs to be on this treatment for 30 mins. Well this is 2 untis that you may get 12 dollars for, but if you have them do some sort of therex (if appropriate) while anodyne is on, can you charge for the therex instead and waive the anodybe...are you starting to get my question? I know how things work in the "real world" but I need to know in the strict letter of the law world...
thanks again

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Re: coding anodyne - December 29, 2004 8:58:00 PM   
SJBird55

 

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The hospital that I recently was employed with did not charge any patient for hot packs or cold packs. We documented that the service was provided, but patients were never charged for that procedure. This was an all across the board policy with all patients.

Logically, I believe that instances that would cause grief would be where certain insurance companies were not billed for services and for the same service Medicare was charged. I could be wrong. With all the reading that I have done, I haven't seen it anywhere that it was wrong to not charge insurance companies for procedures.

I'm assuming that anodyne would be under CPT code 97026. That particular code is within the "supervised modalities" so it is untimed and does not require constant attendance by the therapist. Being that it is untimed, technically only one unit may be billed. (Per [URL=http://www.cms.hhs.gov/medlearn/therapy/billing.asp]www.cms.hhs.gov/medlearn/therapy/billing.asp[/URL] )

You need to remember that your total treatment time needs to justify the units billed.

A suggestion... to capture more money. You said the patient needed 30 minutes of treatment of the anodyne. Only one unit can be charged. Well, you do the anodyne treatment on patient A for 30 minutes AND have another patient B scheduled at the same time that requires direct one-on-one patient contact say for 30 minutes. If patient A needs some direct one-on-one patient contact, then do that procedure next after patient B is done. It's really all a matter of scheduling.

Me personally... I would make sure my total treatment time justified whatever I billed. If the person really needs 30 minutes, then I would do 30 minutes and bill one unit. If the patient needed exercise, but only needed 15 minutes of therapeutic exercise and I was there for that direct one-on-one contact, then I would bill one unit of therapeutic exercise and one unit of infrared. And sure, knowing me, I would probably do the therapeutic exercise in combination with the anodyne to save time if it was still effective to do them concurrently.

(in reply to FLOrthoPT)
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Re: coding anodyne - December 29, 2004 11:04:00 PM   
FLOrthoPT

 

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SJ still missing my point, so no more hypotheticals here is the exact scenario...
the twist here:
this is under a CORF providing part B in the home, so it is not so easy "to see another patient"...now you are starting to see the dilemma...and actually I have been told be a medicare intermediary that it is insurance fraud "to not charge insurance companies for procedures." You "Cannot treat any patients different" that is you cannot waive a charge for medicare patients or add a charge etc if you do not do it all across the board..etc...which you do not if you had a cash paying or wc or car insurance patient...That is not the argument nor the discussion here though, I know what I'd do if it were my clinic or someone else's bottom dollar here, and I think it would be fair to say that common practice would be have that guy on anydone while you see someone else and then work with them when it is done.

The exact scenario is that I cannot send in my PTA to do anodyne knowing that they get paid for being there but the company does not get paid by medicare for the time the patient is on anodyne. So in essence, each PArt B Medicare in home anodyne patient will lose money for the company, Now this company wants to do everything specifically by the book, they do not want the hastle of being audited, so they want to do everything as black and white as possible. Therefore, the question is blatently: PER CMS GUIDELINES: can they do a therex while pt is on anodyne and either
a)not bill anodyne and just bill the therex
b) bill both
c)have to bill for anodyne, have to bill for therex but better make sure treatment is at least 8 mins of anodyne and 8 mins of therex justified by billing and documentation?

Simialr to:IF patient has E-stim on, and you decided to have them do UE strengthening at the same time it is on their back lets say, I think we can all see here that it probably isn't right to bill for both during the same time segment, most of these codes are mutually exclusive, that is you cannot do one while doing the other. You cannot hook up a VMO to russian stim adn bill NM re-ed and Therex at the same time, or E-stim and therex at the same time, etc...so, this is a similar scenario

I am pretty sure while A is the choice most PT clinics would make, I do not think it is acceptable under CMS guidelines. I think b and c are the right answers, that is what I am looking for, CMS clarification if anyone actually knows it, not a "here is what I would do in my clinic" answer...the same way we do not bill for hot or cold b/c it makes our numbers look bad when we have to "write it off" I still am not quite certain that that is technically the legal way to do things, but I do understand it is the "Accepted way of practice"...

So..if anyone knows this answer AS FACT please let me know ASAP...

Ben

(in reply to FLOrthoPT)
Post #: 6
Re: coding anodyne - December 30, 2004 6:16:00 AM   
SJBird55

 

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Ben, please don't ruffle my feathers...

Part B is Part B.... in the home or not in the home. The only thing that may be different since I don't work in a CORF is the level of supervision provided while using assistants.

How about if I ask you a question? Is anodyne supported in literature? Is anodyne effective with the patient population in which you are using it? And... since I saw that anodyne can also be a home rental, why not have the patient rent the thing and do the treatment independently? If a patient can rent a particular piece of equipment, then I would question whether the intervention requires the skill of a physical therapist going in and performing the procedure visit after visit...

As I said before, if a company has a policy to NOT bill for a procedure and that policy is all across the board with all patients and all insurance companies, then I don't see how that can be viewed as fraud. It is not deceitful nor cheating if every patient is treated equally. IF the company does NOT have a policy like that and clinicians don't bill one insurance company because reimbursement sucks but do bill another insurance company because there is good reimbursement... well, to me that is deceitful and cheating, which means that I do believe that scenario would be considered fraudulent. Logic, Ben. It's sad that we look for rules to tell us some things that just logically make sense by the definition of fraud.

Ben, you're looking for a "gray" way out of this one.

Per CMS guideline, the patient can do therapeutic exercise while on anodyne. Anodyne is a supervised modality as I stated before. You can only bill one unit of 97026. As long as you are in direct contact with the patient while the patient is involved in therapeutic exercise for at least 8 minutes, you can bill one unit of 97110. If you do them in conjunction, as I stated previously, you will need to have >23 minutes of treatment provided to justify billing 2 units. Per my fiscal intermediary, WPSIC, "The use of modalities as stand-alone treatments are rarely therapeutic, and usually not required or indicated as a sole treatment approach to a patient's condition. The use of exercise and therapeutic activities has proven to be an essential part of the therapeutic program. Therefore, it is expected that a treatment plan consists not solely of modalities, but include therapeutic procedures (97110-97546)."

I gave you a website... go check it out. Go to the main CMS site and find out your fiscal intermediary and read what is at your fiscal intermediary site. Here is someone you can directly call. I'm sure she can help you out. Tell her you are specifically looking for information for physical therapy services provided by a CORF which is providing part B physical therapy services in the home. Christine Davidson (she is at CMS and if she's in she will answer her phone)... 312.886.3642 and her main speciality is in hospital policy. She may need to connect you to someone else for CORF assistance.

And, Ben.. if you ever do start reading the various rules and regulations, you will learn to not start some post in a forum and then add some "twist." CMS has rules and guidelines for too many situations and their rules and guidelines are not the same all across the board. For example - PTA supervision in an independent practice is different than PTA supervision in an outpatient hospital setting. Also, PT's require supervision in a physician owned physical therapy clinic which is billing PT services as "incident to" AND aides and techs CAN do treatments and those treatments CAN be billed to Medicare.

(in reply to FLOrthoPT)
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Re: coding anodyne - December 30, 2004 7:14:00 AM   
FLOrthoPT

 

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i hate anodyne and I do not believ in modalities so I did not want to even get into that. I am only managing these cases, so as I stated i do NOT want to even get into the idea of anodyne or this scenario except for the billing. This is precisely why I want to know. I told the company that they will lose moeny on each of these cases, therefore it is a good reason not to do it. They themselves marketed to a bunch of docs the efficacy of anodyne for the neuropathy patients and my PTAs are being flooded with these cases and the logistics of getting several anodyne units around the county is pissing me off especially because I do not like anodyne. So I agree and understand what you are saying. I will call that lady thank you. I undersatand the difference sin different settings but my question is general enough that the setting doesn't matter, I was not wondering about supervision, etc. Purely if one code isbeing used during one time segment such as a modality can you bill for anything else during that time. Like if someone is doing an unattended modality can you bill for an attended one during the same time. .. .so the twist didn't matter, doesn't matter, and will never matter, it just seemed that I needed to clarify it so we were on the same page...the only question still stands: Like I said above, if someone is using e-stim on their ankle while you are stretching their neck, can you bill e-stim and manual during that same time segment, my thought is no. Or, someone anodyning their feet while doing any sort of UE exercise (if appropriate) is that able to be billed during the same time segment...That is what I am trying to figure out, so I will call her, thank you.., and SJ ruffling feathers is good for everyone once in a while it sheds the loose feathers and thereby maintains a nice clean coat...

(in reply to FLOrthoPT)
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Re: coding anodyne - December 30, 2004 7:18:00 AM   
FLOrthoPT

 

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it is still confusing though:
Billing - CPT Codes: Permitted

In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where "supervised modalities" are defined by CPT as untimed and unattended -- not requiring the presence of the therapist (CPT codes 97010 - 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.

(in reply to FLOrthoPT)
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Re: coding anodyne - December 30, 2004 7:19:00 AM   
FLOrthoPT

 

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the way i interpret this is yes, you can do e-stim on an ankle and stretch a neck and bill for both...right?

(in reply to FLOrthoPT)
Post #: 10
Re: coding anodyne - December 30, 2004 7:27:00 AM   
FLOrthoPT

 

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From: wellington, fl, usa
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Billing - CPT Codes: Not Permitted

In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients. Examples include:


a-Any two CPT codes for "therapeutic procedures" requiring direct one-on-one patient contact (CPT codes 97110-97542);

b-Any two CPT codes for modalities requiring "constant attendance" and direct one-on-one patient contact (CPT codes 97032 - 97039);

c-Any two CPT codes requiring either constant attendance or direct one-on-one patient contact - as described in (a) and (b) above -- (CPT codes 97032- 97542). For example: any CPT code for a therapeutic procedure (eg. 97116-gait training) with any attended modality CPT code (eg. 97035-ultrasound);

d-Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 - 97542) with the group therapy CPT code (97150) requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112);

e-Any CPT code for modalities requiring constant attendance (CPT codes 97032 - 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035);

f-Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 - 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)


But...then look at
C...so if anodyne is billed under 97039 then it probably wouldn't fly, if it is billed under infrared 026 then go back to Permitted and it should be fine? right?

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Re: coding anodyne - December 30, 2004 1:00:00 PM   
tucker

 

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Sorry for getting off the subject...but for those that are using Anodyne, what are you using it for,...sensation, wound healing, balance? Also, is it working?

I know this company came out with a ton of claims a few years back that had no support (and I am still skeptic), but I recently came across a double-blind, placebo-controlled RCT showing fair results:

Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double-blind, randomized, placebo-controlled study with monochromatic near-infrared treatment.
Diabetes Care. 2004 Jan;27(1):168-72.
Full text at:
http://care.diabetesjournals.org/cgi/content/full/27/1/168

Thanks in advance for any feedback.

(in reply to FLOrthoPT)
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Re: coding anodyne - December 30, 2004 2:51:00 PM   
FLOrthoPT

 

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This is what I did not want to get into debate about...there is an old thread entitled ifrared therapy about this...check it out..and I got all the answers I needed, thanks SJ...it really matter whether you are coding it as 026 or 039 as to what the answer is, we wanted to code it 026 so yes you can bill a therex code during that time since it is supervised modality not an attended one...thanks for your help, I am outta here-
Ben

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Post #: 13
Re: coding anodyne - December 30, 2004 2:52:00 PM   
FLOrthoPT

 

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but quick answer...primarilly for increase sensation/proprioception for neuropathy, some results, not sure if they are from the adjunct treatment ot the anodyne or the placebo effect...

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Re: coding anodyne - December 30, 2004 8:14:00 PM   
SJBird55

 

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Anytime. Gotta love CMS.

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Re: coding anodyne - December 30, 2004 8:16:00 PM   
FLOrthoPT

 

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pprecisely why i stopped taking insurance over a year ago

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Re: coding anodyne - January 3, 2005 4:00:00 PM   
hmgross

 

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I don't have time to post much, but here are a few thoughts. If you do not know what these terms mean: Bundling, unbundling, CCI edits, then you need to go to Insurance Billing and Coding courses. As dull as it sounds, it has been quite valuable for me in the past. You go to the course, pen & paper in hand, ask detailed specific questions (such as the one in this post) and write down the presenters response (including that persons name). It proves you are acting in good faith (keeping a record of your questions/responses) when you submit charges and bill for your services. This is especially important for CMS. I usually see our Executive Director of the MN APTA at these things, and she is very vocal about any billing/coding practices that she sees as "unfair" (can't come up with a more appropriate term right now)and should be changed.
I have found the "Coding and Payment Guide for the Physical Therpist" very useful as well. I don't think I would have much of a business here if I didn't accept insurance so I need to study up on the issues the best I can.

_____________________________

Holly Gross PT

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