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Billing for an Eval and Exercise in the Same Session

Mary R. Daulong, PT, CHC, CHP

July 27, 2012

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Question

If you evaluate a patient and in the same day issue an exercise program in which you educate, demonstrate and have them repeat it, can you bill for the eval and an exercise code if you spend at least 8 minutes with them on the exercise program?

Answer

So, the question is can you separately bill for a home program and an initial evaluation if you spend adequate time doing the home program. The answer is certainly yes. The home program is separate and distinct. It is not a requirement of the evaluation. It is considered an intervention, and you always want to code to purpose. If you are teaching the patient an exercise, this would fall under the exercise code. Let's say, you have a vestibular patient and you are teaching them balance activities, you would code under neuromuscular. Always code to purpose on your home programs. 


mary r daulong

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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