1. Documentation for Insurance Reimbursement Alicia Belant, ATC, LAT, CSCS

2. The Process ReferralInsurance Coverage Authorization

3. The Referral International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM Codes) –ICD-9 CodesICD-9 Codes –World Health Organization –Diagnoses and Procedures –No longer in print, though still used

4. The Referral ICD-10-CM Codes –Published 1/16/2009 –Implemented 10/01/2014 –More descriptive –ICD-10 CodesICD-10 Codes

5. The Referral Appropriate box checked –Why? Follow referral instructions

6. Insurance Coverage Initial Evaluation vs Follow-up Know which companies allow what –Not all companies allow ATC initial eval

7. Authorization Authorize specific number of visits –Worker’s compensation exception Re-submit to gain additional visits Who authorizes?

8. Back to S.O.A.P. Subjective –What do you ask? –Do all of these apply? Insurance looks for ADL limitations! –Personal hygiene/self-care –Ambulation –Work responsibilities –Quality of life

9. Back to S.O.A.P. Objective –Observation/Inspection –Palpation –Range of Motion –Manual Muscle Testing –Special Tests Grading Special Tests

10. Back to S.O.A.P.

11. Special Tests –Already have a diagnosis –Do you perform them? –Post-operative vs non-operative

12. Back to S.O.A.P. Assessment –Also known as “Functional Analysis” –Note what you found Summary of objective findings Differ from diagnosis? –“with involvement of…” or “secondary concern…” –Ex: Rotator cuff strain with biceps brachii involvement as secondary concern –State limitations/deficits –KEY WORDS: Functional, limitations, deficits, activities of daily living

13. Back to S.O.A.P. Plan –“Therapy to address functional deficits” Duration –2x/week, 8 weeks = 16 visits –Look at protocol! Goals –Focus on functional limitations “Decrease patient’s left knee symptoms by 50% to allow for activities of daily living without limitations”

14. Interventions Current Procedure Terminology Codes (CPT) –Eval, Re-eval, estim, US/Phono, Ionto, Hot/cold pack application, Gait Training, Manual Therapy, Therapeutic Exercise, Leather insoles, complex strapping, etc. –http://www.nata.org/sites/default/files/RehabC odes.pdfhttp://www.nata.org/sites/default/files/RehabC odes.pdf Choose all relevant codes

15. Interventions Each code has a value AT vs PT codes 15 minute blocks/7 minute rule – 15-7= 8 Least amount to be billed –Ex: 45-7=38 Least to be billed, 3 units

16. Re-Submitting Go through objective –ROM, MMTs Document any progress made –“hip strength continues to improve” –Will NOT authorize visits without improvement Document limitations in ADLs –“difficulty negotiating stairs persists”

17. Activity Group 1 53 y.o. female –Bank teller Left SLAP lesion repair Subjective questions Objective –MMTs –Special Tests Plan –2 goals Group 2 30 y.o. male –Delivery driver Right meniscal tear, non- operative Subjective questions Objective –MMTs –Special Tests Plan –2 goals