Health Information Management

Q&A: Billing pulmonary rehabilitation along with other therapy services

APCs Insider, August 29, 2014

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

Q: Our MAC is reviewing our pulmonary rehabilitation and physician therapy (PT) and occupational therapy (OT) charges. Therapists provide our services and we bill the therapy using the HCPCS code for pulmonary rehab (G0424). However, we do have a few patients who receive PT and OT services for a different reason–such as a hip replacement. Can we report these rehab services separately?
A: MACs will almost always question reporting of additional rehab services along with the pulmonary rehab services. Because of the definition and instructions, HCPCS code G0424 (pulmonary rehabilitation, including exercise [includes monitoring], one hour, per session, up to two sessions per day) is an all-inclusive code for the pulmonary rehab, regardless of the discipline that provides the rehab services.
You may separately report physical, occupational, and speech-language services provided that have a separate treatment plan and are not related to the pulmonary rehabilitation service. You will need to append a modifier to indicate that the services are separate and distinct.
But expect MACs and other auditing entities to review the services due to the purpose of G0424. The NCCI Manual, chapter 12, states:
Physical or occupational therapy services performed at the same patient encounter as pulmonary rehabilitation services are included in the pulmonary rehabilitation benefit and are not separately reportable. (CMS Final Rule [Federal Register, Vol. 74, No. 226, November 25, 2009, pages 61884-61885]). If physical therapy or occupational therapy services are performed at a separate, medically reasonable and necessary patient encounter on the same date of service as pulmonary rehabilitation services, both types of services may be reported utilizing an NCCI-associated modifier. Similarly physical and occupational therapy services are not separately reportable with therapeutic pulmonary procedures for the same patient encounter.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Florida, answered this question.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular