Question: A modality vendor stopped in to our clinic recently and said that for Part B a therapist can apply an unattended modality (unattended EMS or diathermy) to more than one patient at the same time and all time is billable. Is this correct?
Also could you run through different part B scenarios such as:
1. Therapist supervision 2 part B unattended modalities at the same time and not seeing any other patient.
2. Therapist supervising 2 part B modalities and doing manual therapy with third part B patient.
Answer: The first thing you must realize is that supervised modalities are non-time sensitive so you actually are not billing for your time, you are getting a flat fee for the provision of the service.
Also, for Medicare you can only bill 1 unit of that modality no matter how many locations or length of time you have the patient receiving that particular modality. Because it is not a direct one-on-one modality you can have more than one patient receiving the same or different supervised modalities and it is not considered concurrent therapy(i.e. Medicare is not paying for your skilled time).
Because of this you can provide services to one or more patient receiving a form of supervised modality while treating another patient with a time sensitive procedure or modality such as manual therapy or ultra sound and bill the patient for the length of time you are providing that one-on-one care according to the 8 minute rule. When you go to take the patient of the modality, or increase intensity etc. you stop the time for the individual therapy until you return, or, if you have a tech, they can do that if allowed by your practice act.
A word of warning! Make sure you are not over utilizing modalities. I have seen patient care plans that identify multiple modalities that essentially do the same thing without justification for the different types. Also, multiple modalities can be a red flag and trigger medical review audits.
I have a question regarding billing for attened and unattended Modalities under Med A in SNF. Under the new regulations effective October 1, 2011, do we continue to bill attended and unattended modalities as non time sensitive services?
Hi Jane,
Supervised modalities such as e-stim have skilled and non-skilled components as far as Part A is concerned. The time spent in determining the appropriate placement of the electrodes, application of the electrodes and determining of the appropriate intensity is skilled. Once the intensity of application is achieved, the time spent receiving the treatment is non-skilled as it does not need the direct attendance of the therapist. So the initial time can be counted as individual minutes and the rest is non-skilled meaning you can provide direct treatment to a second patient as individual minutes.
Attended modalities such as ultra-sound are considered all skilled time as the therapist must be physically present applying the ultra-sound. So here the assessment of the appropriate intensity of the US, based on the information provided by the patient, inspection of the area prior to application and the time spent in applying that modality is all skilled time and is included as individual time.
This interpretation actually goes along with the Part B payment as we are paid for the modality, a single flat fee regardless of the time or number of applications.