Health Information Management

Q&A: Can we report CPT therapy codes for services by non-therapists?

APCs Insider, January 16, 2015

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Q: Can we report new CPT® codes 97607 (negative pressure wound therapy, utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application, wound assessment, and instructions for ongoing care, per session; total wound surface area less than or equal to 50 square centimeters) and 97608 (negative pressure wound therapy; greater than 50 square centimeters) under the OPPS? Or are these to be reported only by physical therapists since they are in that section of the CPT Manual?
A: CMS recognized several years ago that some services are provided by both therapists and qualified clinicians. AMA assigns the codes for services performed by therapists to a certain section of the CPT Manual, like it does with all CPT codes. As we know, services provided under a therapy plan of care by a therapist must be reported under one of the therapy revenue codes (042x, 043x, 044x) with the appropriate therapy discipline modifier (-GN, -GO, -GP).
Because specific services can be provided by either a therapist or a non-therapist, CMS created the designation “sometimes therapy.” When a code is designated as “sometimes therapy,” it may be performed by a qualified therapist under a certified therapy plan of care or by another qualified clinician.   
New CPT codes 97607 and 97608 are both designated as “sometimes therapy" services for 2015. They replace HCPCS Level II codes G0456 and G0457.
The full list of therapy services and their designation as either “sometimes therapy” or “always therapy” are listed in Transmittal 3156 and at CMS' website.
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.

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