CPT Codes Defined

CPT Codes Defined

Along with ICD-10 is another term called CPT codes. Nitin Chhoda defines and differentiates these two terms, and explains the impact they will have on the whole physical therapy documentation process.

Practitioners must become familiar with the codes in order to minimize errors upon claim submissions.

CPT codesWhile owners of physical therapy practices are contending with the switch to ICD-10 coding, another term with which clinicians must be familiar with is current procedural terminology (CPT) codes.

CPT Codes

Every procedure, task, service, device and surgery a patient receives is associated with a specific numerical code. Insurance companies utilize CPT codes to determine the amount healthcare providers will be paid and CPT codes must be linked by medical necessity.

The American Medical Association (AMA) develops and copyrights CPT codes. They’re responsible for changing, revising, updating and discarding those that become obsolete as new technology and treatments become available. They encompass thousands of individual codes that are updated annually.

CPT codes, even when used in physical therapy documentation purposes, are uniform and apply to all clients except those with Medicare coverage. Medicare utilizes the Healthcare Common Procedure Coding System (HCPCS) that encompasses three levels of coding.

HCPS Levels

HCPCS Level I is maintained by the AMA and Level II consists of alphanumeric codes. Level III codes were abolished in 2003 and were state-developed for Medicaid and Medicare contractors. Therapists should be aware that the reimbursement amount for each code varies widely among insurers and assigning the correct code to the appropriate treatment is a complex endeavor.

An EMR facilitates the process, but clinic owners will want to ensure their coding and billing expert has the best possible training to manage CPT codes and the upcoming ICD-10 changes, along with a thorough knowledge and understanding of medical terminology. Entering the wrong codes will result in denials and delays in reimbursements.

It’s imperative that physical therapists use the code that most accurately reflects the service or treatment that was provided. It should match the current ICD coding and therapists must provide sufficient documentation to support the CPT code that was entered to avoid denials, audits and requests for more information.

CPT codes definedCPT Codes Standard

CPT codes allow for two-digit modifiers should they be required, but they must conform to standard definitions. Incorrect coding costs valuable clinical time, interrupts cash flow and can delay essential services to clients.

CPT codes provide the means for healthcare providers to communicate effectively with insurance companies about the services, treatments and procedures rendered to any given patient.

Using correct coding is essential if clinicians are to be adequately reimbursed for their expertise and ensures payments reach the clinic in a timely manner.

There is no uniform payment for specific procedures. Each insurance provider has its own fee schedule and reimburses according to the company’s guidelines. Proper coding ensures therapists are reimbursed at the highest possible level.

An EMR provides clinic owners with tools to monitor and track agencies that provide the best reimbursements, allowing them to make informed decisions about the best payers with which to contract.

The use of CPT codes in conjunction with ICD codes directly affects the profitability of practices. It’s a complex system that requires knowledgeable staff, careful attention to detail, and stringent documentation to support every diagnosis, treatment and procedure. An EMR makes the coding and billing process easier, and provides practice owners with the tools to track the best payers for increased revenues.

Insurance Eligibility and Claims Submission: Push-Button Type

Insurance Eligibility and Claims Submission: Push-Button Type

Years ago patients’ insurance eligibility took weeks or months to determine. Now, with the help of electronic medical records, verifying insurance claims happen at the touch of a button. 

Nitin Chhoda describes the push-button feature technology that EMRs are providing in order to streamline the physical therapy documentation process.

insurance eligibilitySubmitting reimbursement claims is one of the most important tasks in a physical therapy documentation process.

It’s also one of the most time consuming, fraught with multiple opportunities for audits, denials and requests for additional information.

Those who have implemented an EMR know first-hand that errors and mistakes can be virtually eliminated through push button claim submissions and insurance eligibility.

EMRs Role to Claims Submissions

EMRs offer the most sophisticated means available to submit claims and verify the insurance eligibility of any patient.

A tablet-compatible EMR allows clinicians to tap a button to submit claims singly or as a batch.

Therapists utilizing an EMR can verify the insurance eligibility and coverage of any client with push button functionality. They can also identify claims that could be red-flagged by insurance providers.

Push-button claims submission allows clinic owners to submit reimbursement claims to a wide variety of payers, from private insurance and military insurers to Medicare and Medicaid.

Physical Therapy Software

Physical therapy management software simplifies and expedites the claims process for reimbursements that are less likely to be questioned and payments that reach the practice’s account quicker. An EMR can be integrated into existing insurance eligibility office systems and streamlines the entire billing process and workflow.

Refiling claims, denials, and responding to requests for clarification and more insurance eligibility information cost practices untold hours of work, effort and lost or late revenues. EMRs use the power of the Internet to file claims in real time that arrive almost instantly, allowing the adjudication process to progress quicker for better cash flow to the clinic.

Push-button claim submissions provide the means for practice owners to send reimbursement requests from the office and any venue where clinicians provide their services.

HIPAA Compliant

The insurance eligibility systems are HIPAA compliant and offer an enhanced level of safety and security for sensitive information. EMRs make it possible to have a patient’s office visit ready for billing even before they leave the building. EMRs provide another essential service for physical therapy clinics.

insurance eligibility and claims submissionThey allow practices to verify a patient’s insurance eligibility and coverage for services with push button technology.

In a time of economic flux, insurance companies and other payers are examining claims closer than ever before.

Insurers are reducing available services to clients and placing monetary caps on the amounts for which they’ll pay. Many patients aren’t aware of the limitations associated with their insurance coverage and are taken completely by surprise when they find out.

Push-Button Feature

Practice owners with an EMR can utilize the push-button feature of an EMR to ascertain if a patient is eligible for coverage, if there are limits on services or monetary amounts, and required co-pays. That feature alone can save clinicians thousands of dollars each year.

People change jobs and lose their insurance, and healthcare coverage is at such a premium in the U.S., that there’s even an active market in insurance identity theft. An EMR provides the tools for clinics to immediately verify insurance eligibility and protect themselves from those who would obtain services to which they’re not entitled.

Push-button technology assists therapists verify a client’s healthcare coverage, and submit reimbursement claims with alacrity and ease for practice profitability. Push-button claims submission and insurance eligibility allows practice owners to submit billing in real time, virtually eliminate errors that slow down reimbursements, and increase cash flow.

That same technology helps therapists determine a client’s available coverage to provide better patient care, while protecting themselves from those that would cheat the system and therapists of their rightful payments.

Medical EMR: How It can Simplify Healthcare

Medical EMR: How It can Simplify Healthcare

Let’s face it. Healthcare is complicated. Nitin Chhoda explains how a good EMR system can simplify healthcare with simple and efficient data entry, better patient communication between provider and patient, and improved interaction between providers.

In this article, learn how to make scheduling, documentation, billing and even marketing simple and systematized in your practice.

medical EMRSpiraling costs for clinics and tougher reimbursement standards are two of the most pressing problems facing physical therapy practices.

An integrated medical EMR offers an elegant and efficient solution to provide an enhanced level of patient care, while facilitating collections and reimbursements.

A variety of individual office systems has been available over the years, but software creators and designers have raised the bar with electronic medical records.

The Best Tool

Today’s integrated systems provide a comprehensive array of tools for billing, scheduling, communications and marketing to keep practices profitable and maintain a superior level of patient care.

EMRs are available as web-based software systems that are compatible with a wide array of tablets. Medical EMR software can also be implemented via on-site servers, but require costly hardware and practice owners are responsible for maintaining their own security and remaining HIPAA compliant.

A web-based system is extremely fast and offers computing in the cloud that can be accessed from any venue where an Internet connection is available. The portability of a web-based medical EMR allows therapists to take advantage of new opportunities to increase their stream of revenue.

Clinicians can extend their services into an array of new avenues, from corporate wellness programs, senior facilities, in-home services and even spas. Modern physical therapy treatments and associated services aren’t just for those who require extensive rehabilitation.

Medical EMR

EMRs excel as a point of billing and coding, expediting reimbursement claims and allowing funds to be deposited directly into the clinic’s account. They significantly reduce errors and mistakes that result in rejections and denials.

If a claim is questioned, additional information and documentation can be sent electronically, via medical EMR, to insurance providers and clearinghouses in a matter of moments instead of waiting weeks or even months to cycle through the postal system. medical EMR

A patient portal is an important part of any integrated medical EMR. It provides the means to contact patients by phone, email, and voice and text messaging, and collect insurance information to verify eligibility before the client arrives at the office.

Patient forms can be offered online to eliminate long waits in the office, schedule appointments, post test results and offer pertinent information. A patient portal makes it easy for clients to make secure payments online.

Therapists alleviate pain and improve the quality of life for millions of clients each year and an integrated medical EMR allows clinicians to begin treatment sooner. EMRs enable therapists to access a client’s records to determine previous treatments and their success rate, along with other information pertinent to future services.

Updates Regularly

EMRs allow patient records to be updated immediately and accessed by multiple healthcare providers for the most current information available. A medical EMR is unparalleled as an advertising and marketing tool. Clinicians can easily ascertain where referrals are originating and identify patients that may self-terminate treatment or pose a financial risk to the clinic.

Marketing efforts can be tracked and monitored, and therapists can locate specific demographics on which to focus for future campaigns. An integrated medical EMR will affect every aspect of a physical therapy practice. A system designed specifically for therapy clinics allows users to customize forms and work smart, not hard.

EMRs are fast, efficient and increase the overall productivity of practices. Clinicians can begin treatment sooner for better patient outcomes, while ensuring a steady cash flow for the practice.

EMR Solution: The Importance of Its Portability and Customization

EMR Solution: The Importance of Its Portability and Customization

If you are using, or about to switch to an EMR system, simplicity and portability are essential requirements.

Nitin Chhoda emphasizes the importance of flexibility in your EMR so that it can be used on any device (laptop, PC, iPad, Android device) with an internet connection

EMRConsumers demand portability in the products they purchase to accommodate a mobile lifestyle, and physical therapists should expect the same convenience in their electronic medical records.

EMRs Should Be Flexible

An EMR that doesn’t offer flexibility and portability is even worse than being chained to a bulky computer and using old-fashioned paper records.

An EMR for physical therapy practices is designed to propel clinicians into the 21st century. That includes the ability to customize as needed and take the system wherever it may be required.

Customization is a key element of an EMR. Physical therapy clinics have their own particular documentation needs and requirements, and an EMR should reflect that.

It should be easy to create custom documents that fit into the clinic’s normal workflow, along with other environments that includes billing and coding, patient communications, and registration. Like a one-size-fits-all garment, a general EMR may work for some clinicians, but it will lack critical features and disrupt the productivity and efficiency of every department.

HIPAA Compliant

Maintaining HIPAA compliance can also be a problem. Some clinicians have encountered difficulty with phrasing that prompts the system to produce unwanted results and is counter intuitive to providing care.

Charting a patient’s care, treatment and results shouldn’t require a call to tech support, and many EMR vendors that claim the ability for complete customization have a very strange idea of what customization entails.

EMR customization should reflect the way patients are seen and the way therapists practice their profession. It should import, export, store, save and organize data in standard document formats.

EMR solutionPortability is key when implementing an integrated EMR system and it should be compatible with tablet technology, allowing clinicians to take advantage of a wide range of revenue opportunities.

EMR Transition

An EMR should transition easily from the exam room to the billing department with equal ease.

Therapists provide a wide array of occupational, therapeutic, sensory and sports related services.

There is also a wealth of additional opportunities available to enterprising practice owners in the form of corporate wellness programs, senior citizen facilities, in-home care and even spas.

A portable EMR can be accessed from any location where an Internet connection exists, allowing clinicians to take their tablet on the road to a wide range of far flung venues.

Most patients think in terms of rehabilitation when physical therapy is mentioned, but the importance of therapeutic massage is gaining traction with clients. Spas and health clubs are just some of the businesses that are contracting with professional therapists to offer those services to their clients.

Portability is Always Important

A portable EMR system provides the means to capitalize on those opportunities with complete evaluations, documentation, insurance information and billing from any location.

Therapists provide essential services to assist their patients maintain or regain mobility, end pain and enhance quality of life. A portable and customizable EMR allows clinicians to accomplish those goals through increased efficiency and productivity.

An integrated EMR system will play a growing role in how therapists practice their profession, deliver services and interact with patients. It’s essential that a clinic’s EMR provide the ability to grow with the practice, while allowing clinicians to take advantage of the many income opportunities available.

The Impact of ICD-10 on Billing Staff

The Impact of ICD-10 on Billing Staff

One of the areas that will be most impacted by the switch to ICD-10 will be the billing department. The ability of billing and coding staff to keep up with the increased coding requirements will have a direct impact on the continued flow of revenues to practices. Staff will need sufficient training in the new codes and even then, it may be necessary to engage additional personnel to address back logs.

After the deadline, any claims that aren’t submitted using ICD-10 will automatically be denied. Coding and billing staff will need the highest level of training available. People learn by doing and whenever possible, it’s a good idea to start using dual coding.

Practitioners that have their billing done by a professional agency will need to consult with the company to ensure the firm is prepared and revenues won’t be disrupted. Part of biller/coder readiness is ensuring that they and the software used is compliant with the strict HIPAA standards governing the electronic transmission of patient data.

Billers and coders may also need a refresher course in anatomy and physiology. The increased specificity of ICD-10 will require more in-depth coding. Billers/coders will find themselves using more specific terms than they’re normally accustomed. Next to the clinician, billers/coders are the most important link in the revenue chain. They must be ready for the transition or revenues will falter.,

Some interruption in the revenue flow will be inevitable. By its very composition, the new alpha-numeric coding system requires billers/coders to switch between a numeric pad and a keyboard, which will result in a slowing of coding claims. Super bills may no longer be a feasible option, requiring billers and coders to learn new forms and formats.

There are bound to be claims that are rejected in error due to the new coding. Claims will require resubmission and coders/billers will find themselves investing a significant amount of time communicating with clearinghouses and payers to determine why claims were denied. No matter how well trained the biller/coder is, those type of instances will slow down the submission and collection management process.

Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.

Clinicians must adhere to coding guidelines if billers are to submit accurate claims. Practitioners can’t code for a suspected or probable diagnosis; items that would appear in notes must now be coded; coding should be done at the highest level possible; and a focus should be on medical necessity.

Clinicians and billers/coders have always had a partnership in terms of revenues and that relationship will be even more important as ICD-10 goes into effect. The billing department should be encouraged to seek verification and understanding of any item for which they’re unsure and clinicians should make time for this.

No one can hide from ICD-10. How each team member responds to its challenges will define the ultimate success of the practice and revenue flow.

The Funniest ICD-10 Codes

The Funniest ICD-10 Codes

Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new
ICD-10 codes an accurate indicator. Some of the codes seem nonsensical or unlikely. The fact that the codes exist amply demonstrate that these incidences have occurred – and multiple times in some cases.

There’s an extensive array of items that can be thrown, tossed and dropped that will cause injury. Most will lead to a visit to the ER or the physical therapist. Clinicians will definitely want to be ready for patients who have been hit by rowdy wildlife, from dive bombing macaws (W61.12XA) to head butting cows (W55.22XA) who may object to being milked.

If Grandma gets hit by a reindeer, code it as a V06.00xA, but for individuals who get thrown from a sleigh pulled by reindeer, that’s a code V80.929A. People interacting with churlish chickens with a propensity for throwing themselves at bipeds will code as a W6a.32XA. The codes make no differentiation between rubber chickens and real chickens, but there are codes for multiple encounters.

Land animals aren’t the exclusive cause of injuries. For the luckless patients who experience injury at the fins of water-dwelling creatures, it may feel like a script for a disaster movie. Clinicians will find coding options for clients with first and subsequent encounters with outraged orcas (W56.22xA), those who have been exposed to turtles (W59.29) and not-so-playful dolphins (W56.02XA).

Some individuals are just unable to multi-task while doing even the simplest things. Distracted talking and texting has led to multiple mishaps that practitioners will be coding for and may lead to some strange encounters with payers. There’s a code for people running into a lamppost (subsequent encounter, W22.02XD) and when walking the family canine (W54.1XXA).

Mankind is adept at conceiving new ways of having fun and doing it in the most dangerous venues possible. Bungee jumping (Y93.34), parasailing (Y93.19) and even playing a percussion instrument (Y93.32) or Y93.J4 for lips stuck to an instrument, can lead to unwanted conclusions. A friendly game of ultimate Frisbee (Y93.74) is cited as the reason for pulled muscles, broken bones and even whiplash.

Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.

When hair causes constriction (initial encounter) clinicians will turn to code W49.01XA and E928.4 for an external hair constriction. For a non-scarring hair loss, there’s code L65.9. There’s no telling when a bad hair day will result in serious injury.

Even the very air is fraught with potential danger. For clients who discover they have an air leak, use code J93.82. Patients may be injured through falling spacecraft (V95.49XA). When clients displace their balloon, code it as a T82.523S, but for victims of a falling alligator, that’s code W5803XA.

ICD-10 codes reflect real incidents and complaints, but the ways in which they’re worded often make them fodder for fun. The primary points clinicians need to remember is that they need to code to the highest level possible and as accurately as possible – even if it results in long conversations with payers who have disbelieving minds. Perhaps they could code for a therapeutic massage.