Health Information Management

Q/A: Reporting cardiac rehabilitation and physical therapy together

APCs Insider, October 12, 2012

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Q: We are seeing a patient in our cardiac rehabilitation program. She began having back pain and is now receiving physical therapy services in our rehabilitation department. When we report the physical therapy (PT) services and cardiac rehabilitation services for the same day, we are getting an edit that the PT is included in the cardiac rehabilitation. Can we use a modifier since the PT is for a different reason?

A: Cardiac rehabilitation programs require a physician prescribed exercise program to meet the CMS benefit requirements. Many providers have physical therapists involved in their cardiac rehabilitation programs to oversee the exercise portion. 
Because the codes for cardiac rehabilitation are comprehensive and cover all components of a cardiac rehabilitation program, the exercise services are not separately reportable when provided by a therapist. 
However, in the circumstances that you describe, the physical therapy services are being provided to treat her back pain. If the therapy is provided at a separate session on the same date of service, and all therapy service requirements are documented and met (e.g., physician/NPP authenticated plan of care, documentation to support PT timed and untimed services, etc), then the services can be reported separately with an appropriate modifier appended. 
The National Correct Coding Initiative Coding Policy Manual for Medicare Services, chapter 12, supports this: 
Physical or occupational therapy services performed at the same patient encounter as cardiac rehabilitation services are included in the cardiac 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 cardiac rehabilitation services, both types of services may be reported utilizing an NCCI-associated modifier.
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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