How do you recommend accounting for a therapist's time when a treatment session goes haywire? For example, while ambulating, the patient is incontinent and you have to help the patient get cleaned up as well as cleaning up the area of the clinic. Can the therapist bill for any of that, even though it is not skilled? And what about unbilled minutes for hot packs? Can that be included in total time?
Answer
The answer to the first part of the question is no. Time cleaning up a patient and/or treatment area is not billable because it is not skilled. Anyone could do that cleanup. You cannot bill for that. However, if you have a patient who needs blood pressure monitoring and is physiologically unstable, you can bill for that. The question then becomes what code do we bill it under? This will pull you out of the 97000 series of codes, into more of the observation/medical attendance codes.
As for the hot pack minutes, it does not count in the one-on-one time, but it can count for the total visit. We have to remember that when we document what we have done, we are documenting also for liability reasons - to show that the procedure was performed. This is the same thing for rest periods. If you have a 5-minute rest period, you document a 5-minute rest period, but I would include that in the overall time because that is the period of time that you are liable for the patient in the clinic.
Mary R. Daulong, PT, CHC, CHP
Mary Daulong, PT, CHC, CHP has a very diverse practice background which includes private practice ownership, corporate managed services and hospital based practice exceeding four decades. Her consulting company was established in 1985 and has been, for the past ten years, 100% dedicated to working with healthcare professionals in the areas of federal and state compliance, practice and business office operations, payment and coverage policy including billing, coding and documentation. Her company also provides rehabilitation specific compliance policy and procedure manual production and provider enrollment services.
Mary has been certified in Health Care Compliance since 2002 and is a member of the Healthcare Compliance Association she is also certified as a HIPAA Professional by the HIPAA Academy. Mary has been an active member of the APTA and just recently served as its Risk Management Committee chair. She is a member of the APTA’s State Reimbursement Chair Forum and has held the position of Chair of the Texas Physical Therapy Association’s Payer Relations and Payment Policy Committee for nearly six years. She served for five years on the Texas Board of Physical Therapy Examiners as well as was a member of its Executive Council for PT and OT and Investigations.
Mary has presented well over one hundred (100) courses related to compliance both on a federal and state level often being the featured speaker at National, Chapter and Section Annual Conferences.
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