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Documentation and Billing for Aquatic Therapy

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1.  Your patient is 4 weeks post TKA, complete healing of the surgical incision and cleared for aquatic exercise. Which of the following statements would you use to justify the initiation of aquatic exercise to the insurance company for authorization? The patient states they love the water and prefer water exercise Due to patients continued edema limiting their ROM and pain with stance phase of gait the aquatic therapy is recommended to maximize the benefits of hydrostatic pressure and buoyancy while performing strength and balance exercises The doctor has ordered aquatic therapy The aquatic environment allows the patient to move easily

2.  Your patient is recovering from Guillain Barre and has generalized weakness with a gross muscle strength of the extremities 3/5. ________ would allow for assisted movement and gradual progressive strengthening while supporting the trunk in vertical, functional positions and gait Buoyancy Drag forces Hydrostatic pressure Warmth of the water

3.  Which of the following statements demonstrate skilled therapy was provided? The patient required moderate cues for correct performance of exercise and min assist for recovery of LOB in chest deep water The patient walked forward and backward 10 min in chest deep water holding noodle The patient tolerated water exercises without pain All of the above indicate skilled therapy services provided

4.  "The patient balanced on one leg in calm, chest deep water without pain or LOB for 60 seconds therefore added closed eyes and light turbulence conditions to the exercise, progressing balance challenges." This a statement that demonstrates______ Medical Necessity for aquatic therapy Benefits of aquatic therapy Skilled therapy services provided All the above were clearly demonstrated in the statement

5.  Which of the following are common errors in documentation leading to denial of payment for aquatic therapy services? Aquatic therapy not indicated as medically necessary Repetitive exercise and check marks on aquatic flow sheet Lack documentation of functional progression outside aquatic exercise All of the above

6.  Which of the following are ways to demonstrate progress in your daily documentation for an aquatic therapy session? Subjective reports on improved functional tolerances since the start of care or in the last week Noting level of difficulty/ intensity and duration of each exercise performed Comment on progression towards long term goals in plan of care All of the above

7.  Which of the following is true about the importance of documentation? The main reason for documentation is to get paid for your services Good documentation will prevent you from being sued The longer the report and notes the better Allows for a picture of the patient's performance and progression regardless of who is reading the note

8.  "Proof" is one of the 7 "Ps" in documentation. What does the note have to prove? Prove you are professional therapist Prove the patient was treated that day and treatment is effective Prove there is no reason for liability suit All of the above

9.  When it comes to Medicare and billing aquatic therapy which of the following statements are true? There are no diagnosis code limitations when treating with the 97113 (aquatic therapy) CPT code For all treatments performed in the water the 97113 (aquatic therapy) CPT code is applied. When using a community pool you must have only therapy patients in the pool (exclusive use of the pool) in order to bill Medicare. Following individual state laws, a PT aide/ tech can supervise a patient in the pool while the therapist works with another patient and bill that time as direct contact minutes.

10.  You are the only therapist in the pool you begin treatment on patient A at 1pm performing aquatic manual therapy techniques for 15 min and individualized aquatic exercise for 30 additional minutes. Patient B arrives at 1:45 pm you then have both patients perform various water walking and balance exercises at levels specific to each individual with feedback for correct performance for 15 minutes. Patient A leaves and Patient B now receives 45 minutes of one on one individualized aquatic exercise to improve ROM and strength. Paitent B's session ends at 2:45pm. Which of the following is the correct coding for billing? Patient A 97113 (aquatic therapy) 2 units, 97140 (manual therapy) 1 unit, 97150 (group code)1 unit and Patient B 97113 (aquatic therapy) 3 units, 97150 (group) 1 unit Patient A 97113 (aquatic exercise) 4 units, 97150 (group) 1 unit and Patient B 97113 (aquatic exercise) 4 units, 97150 (group) 1 unit Patient A 97113 (aquatic exercise) 4 units and Patient B 97113 (aquatic exercise) 4 units Patient A 97113 (aquatic exercise) 3 units, 97150 (group) 1 unit and Patient B 97113 (aquatic exercise) 3 units, 97150 (group) 1 unit