Long-Term Care

Coding O0400, Therapies

MDS 3.0 Insider, November 14, 2011

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Version 1.07 of the RAI User’s Manual contains many changes that went into effect October 1. Keeping track of all the changes is enough to make your head spin. So let’s take it one step at a time and look at some of the new coding instructions for Section O0400 (future issues will cover the remaining changes to Section O0400):

  • Co-treatment for Part A: When two clinicians, each from a different discipline, treat one resident at the same time (with different treatments), both disciplines code the treatment session in full. All policies regarding mode, modalities and student supervision must be followed. The decision to co-treat should be made on a case-by-case basis and the need for co-treatment should be well documented for each patient.
  • Co-treatment for Part B: Therapists, or therapy assistants, working together as a “team” to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient. CPT codes are used for billing the services of one therapist or therapy assistant. The therapist cannot bill for his/her services and those of another therapist or a therapy assistant, when both provide the same or different services, at the same time, to the same patient(s). Where a physical therapist (PT) and occupational therapist (OT) both provide services to one patient at the same time, only one therapist can bill for the entire service or the PT and OT can divide the service units. For example, a PT and an OT work together for 30 minutes with one patient on transfer activities. The PT and OT could each bill one unit of 97530. Alternatively, the two units of 97530 could be billed by either the PT or the OT, but not both. Similarly, if two therapy assistants provide services to the same patient at the same time, only the service of one therapy assistant can be billed by the supervising therapist or the service units can be split between the two therapy assistants and billed by the supervising therapist(s).

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