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Billing for Re-Eval When Discharging Part B Patient

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, CFPS, OTD, OTR/L, CMDCP, CDP, CFPS, CGCS

October 21, 2015

Question

Do I always bill for a re-evaluation for Part B when I am discharging?

Answer

No.  You do not have to.  The re-eval code needs some requirements met when billing with it.  Re-eval would be appropriate when you truly are re-evaluating. Perhaps there has been a change in condition, function, long-term goals, your treatment plan, or something has come up that requires you to re-evaluate this patient.  Just because you are doing a discharge summary or an updated plan of care or 701, does not mean that you would bill a re-eval.  To that point, there was a time period in our therapy history when that is exactly what we would have done.  If you go back to the LCD for your MAC, it will probably spell out very specifically what they want to see to justify the re-eval. 


kathleen d weissberg

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, CFPS, OTD, OTR/L, CMDCP, CDP, CFPS, CGCS

In her 30+ years of practice, she has worked in rehabilitation and long-term care as an executive, researcher, and educator.  She has established numerous programs in nursing facilities and authored peer-reviewed publications on topics such as low vision, dementia, quality care, and wellness. She has spoken at numerous conferences, both nationally and internationally. She provides continuing education support to over 30,000 therapists, nurses, and administrators nationwide as National Director of Education for Select Rehabilitation. She is a Certified Alzheimer’s Disease and Dementia Care Trainer, Certified Dementia Care Practitioner, Certified Montessori Dementia Care Practitioner, Certified Fall Prevention Specialist, a Certified Geriatric Care Practitioner, and Trauma Informed Educator.  She serves as the Region 1 Director for the American Occupational Therapy Association Political Action Committee and is an adjunct professor at Gannon University in Erie, PA.


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