A Glimpse into The New Therapy CPT Codes
It is 2018! Along with the New Year, comes changes to the Current Procedural Terminology (CPT) codes. Effective January 1, 2018, CPT code changes occurred involving cognitive rehabilitation and prosthetic/orthotic training. These changes will affect the coding for skilled PT, OT, and ST services for patients who demonstrate functional cognitive deficits and those who demonstrate the need for prosthetic/orthotic training. No need to worry, we’ve got the scoop!
Which CPT codes are affected and what will happen to the affected CPT codes?
As of January 1, 2018, the following codes will no longer be valid and will be retired:
- 97532 Cognitive Skills Development
- 97762 Checkout for orthotic/prosthetic use, established patient
are the new codes that replace CPT code 97532?
For all providers billing for cognitive treatment the following codes will replace the previous 97532:
- G0515 Development of Cognitive Skills – to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes. CMS has mandated that this code be used for all Medicare patients.
- 97127 Therapeutic Intervention – focuses on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact. Use of this code will be limited in the SNF environment but will affect those patients with a traditional insurance plan who do not qualify for Medicare benefits.
**For Speech Language Pathologists, per ASHA, CPT Codes G0515 and 97127 should not be billed for the same patient on the same day as 92507 (speech, language, voice, communication treatment).
What happens now that CPT Code 97762 has been retired?
The following changes have been made to the CPT codes for prosthetic and orthotic training:
- 97760 Orthotic(s) management and training – (including assessment and fitting when not otherwise reported, upper extremity, lower extremity and or trunk, initial orthotic(s) encounter, each 15 minutes. Use of this code should be billed only once per episode of care.
- 97761 Prosthetic(s) training, upper and/or lower extremity initial prosthetic(s) encounter, each 15 minutes. Use of this code should be billed only once per episode of care.
- 97763 Orthotic(s) / prosthetic(s) management and/or training, upper extremity, lower extremity and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes. This code cannot be billed on the same date as 97760 or 97761.
Therapists must continue to be mindful when determining which codes to use for treatment. It is essential for therapists to choose the most specific, appropriate code when billing for treatments. Additionally, therapists must ensure their documentation is thorough and contains the required elements to properly bill for each code.
Therapy companies and therapists alike must be aware of how the electronic documentation they use implements the use of the new CPT codes and how it affects any of the existing Plans of Care that carry over from 2017. All of the therapy software companies have different processes in transitioning from the retired CPT codes to the new CPT codes in their software.
Bethany Nichols, PTA
Director of Medical Review, Century Rehabilitation
Century Rehab offers the following Medical Review & Appeal services:
- Training on how to complete an appeal
- Provide all necessary forms and sample letters
- Auditing of current claims to identify potential deficits in documentation, coding, clinical compliance, and regulatory compliance
- Managing and processing all aspects of the ADR and medical appeals process
To learn more, please email Bethany Nichols, Director of Medical Review, at firstname.lastname@example.org.