Question: I have some questions for you about Part B Outpatient services:
In the outpatient setting does there have to be physicians on-site and a daily “Dr. on call” that is indicated on the billing charge in order to be covered by Medicare? One of our sites does not see Medicare patients because of this reason but I don’t know that it’s a valid point. You didn’t mention it in your class.
Next, is the “GP” modifier necessary for billing under each procedure? (I am not referring to the 59 modifier)
Finally, a plan of care only has to be updated or “certification for continuation” signed when the original time and # of visits is up on the original POC and there is no requirement for the patient to see the physician, correct?
Answer: There is no requirement from Medicare that a physician be on premise. There was concern over hospital based OPT clinics because of the Hospital Outpatient Guidelines, but it was not included. There would never be any treatment done if that applied!!!!
Yes, the GP modifier must be on every line of the claim. It indicates treatment was performed under a PT POT, the same applies to the GO modifier for OT and the GN for Speech.
Yes, the POT only needs to be updated if the certification interval is met and the patient needs more treatment.
There is no requirement that the patient be seen by a physician either before. during or after treatment unless the physician requires it.
If someone has received 2 units of manual therapy (23 min One-on-one) and then receives an ultrasound treatment, does the documentation then have to show 38 min of one-on-one in order to receive reimbursement for the ultrasound treatment? Also, when prescribing a home exercise program for a patient is it necessary to document that the patient actually performed the exercises during the visit and is the CPT code 97110 or 97535 more appropriate in that scenario?
Thank you,
Medicare requires that you identify the total direct one-on-one time and then allocate the units based on this time. Therefore if your total direct time for the ultra sound was 3 minutes assessment, 8 minutes of treatment for a treatment time of 11 minutes, your total direct time would be 23 plus 11 equals 34, therefore you could only bill 2 units.
When teaching your home program, you bill it to whatever is the type of exercise you are teaching. most of the time it will be under therex – 97110. Your documentation should show that the patient performed return demonstration of the exercise. I personally like to include the level of understanding of the program and the accuracy based on the number of exercises taught.
I hope this helps.