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Medicare Part B Coding and Billing: For Occupational Therapy Services in Long-Term Care

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1.  Which of these is NOT a requirement of documentation:
  1. All documentation must be completed by the registered therapist
  2. Documentation must support medical necessity
  3. You must document treatment minutes
  4. Daily notes should identify each specific skilled intervention to justify coding
2.  Which of these is true regarding modality interventions?
  1. All modalities are time based codes
  2. Constant attendance means that you need to be in the general vicinity of the patient
  3. Modalities are not generally stand-alone treatments and should be delivered in conjunction with other therapeutic procedures
  4. Modalities can be delivered indefinitely, even if symptoms subside/function improves
3.  Which of these is true regarding CPT 97760, orthotic(s) management and training?
  1. It is an initial encounter code. This means that this code can only be billed once per discipline per patient episode.
  2. Repetitive range of motion prior to placing an orthotic/positioner to maintain the range of motion is not reasonable and necessary.
  3. Ongoing therapy visits for increasing wearing time are generally not reasonable and necessary.
  4. All of the above
4.  Supporting documentation for CPT 97110 include which of the following:
  1. Objective measurements of loss of strength and range of motion (with comparison to the uninvolved side) and effect on function
  2. Specific exercises performed, purpose of exercises as related to function, instructions given, and/or assistance needed to perform exercises to demonstrate that the skills of a therapist were required
  3. Rating scales including pain rating scale if used for pain and pulse oximetry, heart rate, blood pressure, perceived exertion, etc. when cardiopulmonary monitoring is required
  4. All of the above
5.  CPT 97112 is considered reasonable and necessary for all but which of the following:
  1. Muscular weakness, flaccidity, hypo- or hypertonicity
  2. To remind a patient to ask for assistance and slow down to prevent falls
  3. Poor static or dynamic sitting/standing balance
  4. Loss of gross and fine motor coordination
6.  Which of the following is FALSE regarding CPT 97535?
  1. CPT 97535, self-care/home management training, should be used to code all home instructions/home programs
  2. Documentation must not show that the patient is practicing techniques already taught
  3. Training should be focused on a functional limitation(s) in which there is potential for improvement in a functional task that will be meaningful to the patient and the caregiver
  4. CPT 97535 is used for ADL, safety procedures, and instructions in the use of adaptive equipment and assistive technology for use in the home environment
7.  Which of the following statements is TRUE regarding Occupational Therapy evaluation/re-evaluation:
  1. Tests and measurements, ROM, or MMT codes can be billed on the same day as the initial evaluation
  2. Screenings are billable services
  3. In choosing the correct evaluation code, components including the occupational profile and client history (medical and therapy), assessment of occupational performance, and clinical decision making must be considered.
  4. The re-evaluation code should be used to code/bill for completing routine documentation such as progress reports
8.  Which of the following is TRUE regarding billing CPT codes:
  1. The total number of units that can be billed is constrained by the total treatment time
  2. It is acceptable to record "Time in/Time out" as a record of your treatment session
  3. It is okay to "round" minutes to the nearest 15
  4. It is permissible to bill for time the patient spends waiting for the therapist, waiting for an apparatus to be available, toileting, etc.
9.  Which of the following is NOT TRUE regarding Functional G Codes:
  1. G Codes should be documented at the outset of therapy in the evaluation/POC or treatment note
  2. Two G-codes are reported each time: a current/discharge status and a goal status
  3. Therapist assistants can determine G-codes and modifiers
  4. Once the G-code is chosen, a corresponding severity modifier is used to indicate the level of impairment
10.  Common reasons therapy services are denied include:
  1. Services over the Medicare Part B cap are not justified
  2. CPT codes do not reflect services provided/documented in the therapy notes
  3. Unit to minute conversion (i.e., 8-minute rule) was not applied correctly
  4. All of the above

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