![]() New and revised Physical Medicine and Rehabilitation Codes (Effective January 1, 2018)įor CY 2018, the CPT Editorial Panel revised the Physical Medicine and Rehabilitation codes for a physician or other qualified health care professional (ie, therapist) required to have direct (one-on-one) patient contact to report orthotic and prosthetic management and training services by differentiating between initial and subsequent encounters. If not properly documented, the code will be denied.Documentation must be appropriate to support the CPT code that is utilized.This statement means that CPT codes are not "profession specific." Any qualified health care professional can utilize any code as long as the code description fits the procedure or service the qualified health care professional is providing.In selected instances, specific instructions may define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency)." (CPT Code Book, Page xii) "Throughout the CPT code set, the use of terms such as “physician,” “qualified health care professional,” or “individual” is not intended to indicate that other entities many not report the service. For complete descriptions and listing of all current CPT codes, and their modifiers, please refer to Centers for Medicare & Medicaid Services page or the most recent official American Medical Association (AMA) CPT Code Book with rules and guidelines from the AMA’s CPT Editorial Panel, as well as other resources commonly found on the internet. The following list of CPT codes and commonly used modifiers is in no way exhaustive and represents the codes and modifiers most often used in clinical practice by ATs. ![]() Then, Total RVU x Conversion Factor = Allowable reimbursement.( Malpractice RVU x Malpractice GCPI) = Total RVU.( Practice Expense RVU x Practice Expensive GPCI) +.( Physician Work RVU x Geographical Practice Cost Indices (GPCI) ) +. ![]() Below is the formula used to calculate payments for furnished services: The calculation of a code’s RVU is simpler than it seems. ![]() Insurers generally pay health care professionals for services based on submission of a claim using one or more specific CPT codes. It is important for athletic trainers (ATs) to understand how insurers reimburse health care providers for services rendered. The majority of commercial insurers base their reimbursement levels on either the Medicare fee schedule or RVUs. Medicare fee schedules are based on RVUs. RVUs are the standard measurement in analysis of reimbursement and payer contracts, physician compensation and productivity, and practice staffing and operating costs. Each CPT code has a relative value unit (RVU) assigned to it, a rate that is reviewed every few years. The Centers for Medicare and Medicaid Services (CMS) uses the CPT coding system to establish reimbursement to Medicare providers. (For additional information on ICD-10 codes, please refer to the ICD-10: Understanding the Basics document). While CPT codes are similar to ICD-10 codes, CPT codes identify services rendered, whereas ICD-10 codes represent patient diagnoses. The coding system, developed and maintained by the American Medical Association (AMA), offers health care providers “a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency.” CPT codes are not the same as ICD-10 codes. The CPT coding system describes medical, surgical, and diagnostic services performed by physicians and other health care professionals. Overview of Current Procedural Terminology (CPT) Coding System ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |