Occupational Therapy

Occupational therapy (OT) is a type of therapy that helps individuals of all ages to develop or maintain the skills necessary for daily living and working. Occupational therapists work with individuals who have physical, developmental, emotional, or cognitive disabilities or limitations. They focus on improving the individual’s ability to perform everyday tasks, such as dressing, grooming, cooking, and using technology, to enhance their quality of life and independence.

OT may involve exercises and activities designed to improve fine motor skills, coordination, balance, and sensory processing, as well as adaptive strategies to help individuals modify their environment or routines to better suit their needs. Occupational therapists also work with individuals who have suffered a stroke, injury, or illness to help them regain their ability to perform daily activities and to prevent further disability. Overall, occupational therapy aims to support individuals in achieving their goals and participating in meaningful activities.

Occupational Therapy Billing & Credentialing

Billing and Coding for occupational therapy practices is evolving every year. Even with the new 3-level evaluation codes put into place this year, CMS is still collecting data throughout 2017 to see if there need to be more changes made to how occupational therapists are reimbursed. There are multiple rules and regulations for occupational therapy billing and coding. Every insurance company is different, which is why checking eligibility, submitting authorizations and documentation and adhering the correct modifiers to your patient’s claims can be a daily task that many offices struggle to learn and understand.  Medwave and its professionally trained staff are here to help you and your office succeed in submitting your claims correctly and affordably.

Keeping Compliant

The first step to ensuring that you and your occupational therapy practice are on the right track is to make sure that you are documenting your patient’s visits correctly. Correctly documenting your patient’s notes can be the difference between getting paid and acquiring authorizations and losing thousands of dollars in income a year.

New Occupational Therapy Evaluation Codes

As of January 1^st, 2017, the CPT code 97003 for an occupational therapy evaluation and 97004 for occupational therapy re-evaluation will be replaced by 4 new CPT codes. The new codes will allow therapists to make a more specific evaluation based on the complexity of the patient’s diagnosis and performance.

Patient Specific Functional Scale

The patient-specific functional scale score is being used by multiple insurance companies as a way to properly measure a patient’s functional condition. Before being evaluated, the patient is asked to list as many as three activities they are having trouble performing based upon their diagnosis. Once identified, they will point to a number scale from 0-10, 10 being fully functional, and score how they deem themselves able to perform that activity. This will be completed before the initial evaluation and upon every re-evaluation after.

Patient-specific activity scoring scheme (Point to one number):

0          1          2          3          4         5         6          7          8          9          10

Unable to perform                                                                                          Able to perform

Functional Reporting using G-codes

As of January 1^st, 2013, it is required to append “G” codes to the initial visit, at least every 10^th and upon the discharge of treating a patient under Part B Medicare. Highmark BCBS has now initiated the same policies for tracking the functional limitations of a patient. As of July 2017, all claims will be denied if G-codes and their modifiers are not used.

Severity Modifiers

Modifiers are needed to more accurately show the level of functional status the patient currently has and the goal being reached. There are a total of seven modifiers to choose from:

When submitting claims for Medicare it is still necessary to append the GO modifier to show the service is being performed as outpatient occupational therapy.

Medwave has a dedicated team of medical billing and credentialing experts to help you maximize your office’s reimbursement and keep you up-to-date with today’s ever-changing medical billing and coding regulations. Our team is experienced and well educated in the medical billing and coding guidelines of occupational therapy and has firsthand experience working with commercial, government, auto and workman’s compensation companies to get your claims paid fast and efficiently.

Our sole objective is to move your office to a more efficient and effective work process so that your claims reimbursement is at its maximum. Utilizing the most current ICD-10 and CPT coding ensures that your office’s claims are clean and paid the first time. Our staff is here to help you and your office succeed in preparing claims and getting reimbursed.