Pediatric therapy professionals are always learning, evolving, and finding new ways to help their patients. This ongoing process can include keeping up with industry journals, reading books, and attending seminars. Blogs written by fellow OT, PT, or SLP specialists are another fantastic option, and they usually take less than 10 minutes to read. You can learn valuable information about industry trends, get inspired by stories of patient successes, or dive deep into an innovative technique. This collection of high-quality OT, PT, and SLP blogs will make for insightful reading in 2021.      

Physical Therapy Blogs

Pediatric physical therapy blogs to follow.

Athletico Physical Therapy 

This national network of Physical Therapy clinics offers top-notch care for people of all ages, especially athletes. The Athletico Physical Therapy blog is a collaborative effort from many of the clinic’s PT professionals, which makes a very diverse and informative resource. Posts dive into every aspect of patient care, including the best way to treat specific injuries, how to motivate patients, and the importance of empathy.  

Mike Reinold 

Mike Reinold is a noted physical therapist and athletic trainer who has worked for the Boston Red Sox. His well-established blog covers a broad range of physical therapy topics, but with a focus on exercise and helping active patients stay injury-free. You’ll also find plenty of practical advice for professional development in the PT field, including managing your workload and collaborating with other healthcare professionals. Mike also explores these topics on his podcast.  

Starfish Therapies  

This pediatric physical therapy blog written by Stacey Menz is geared towards supporting both parents and PT professionals that work with children. She is the owner of Starfish Therapies, a clinic that provides rehabilitation services to patients from the age of zero to 22. Her blog offers detailed advice on how to encourage strength, coordination, motor development, and much more. Many of the posts have specific exercises and activities, including games, stretches, and tips for using mobility tools. 

Occupational Therapy Blogs

Pediatric occupational therapy blogs to follow.

The OT Toolbox  

Colleen Beck has been an occupational therapist for more than 20 years, including school-based settings and early intervention. She has worked with children with fine motor deficits, sensory processing dysfunction, and many other challenges. The goal of The OT Toolbox is to promote the healthy development of kids with play-based learning and evidence-based practices. Her approach is always very informative, and every activity suggestion has a detailed explanation for why it can help kids develop specific skills.    

Skills 4 Life 

Along with being a pediatric occupational therapist with 3 decades of experience, Karina Black knows what it’s like to be a special needs child. She struggled with school throughout her childhood because of a visual impairment and poor hand-eye coordination skills. She went on to found a pediatric occupational therapy practice in 2010. Karina specializes in helping kids with handwriting, dyslexia, executive function skills, and more. The Skills 4 Life blog is regularly updated with actionable, well-researched interventions that can help children develop necessary life skills.   

Growing Hands-On Kids  

Heather Greutman writes a popular resource for parents, teachers, and pediatric occupational therapists. She’s on a mission to help children reach their potential with enriching, hands-on play. Growing Hands-On Kids is full of creative ideas for engaging children in enjoyable activities that improve their fine motor skills. You can also read thoughtful posts on developmental milestones, handwriting skills, and the importance of creating a sensory diet.  

 My OT Spot 

This informative blog is an amazing resource for anyone that’s just getting started with a career in occupational therapy. Sarah Stromsdorfer is on a mission to help new OT professionals thrive by providing useful content for every step of the journey. My OT Spot has thoughtful advice on how to be more productive, managing the emotional challenges of being an OT, and using evidence-based practices.   

The Inspired Treehouse 

This popular blog is the collaboration of two practicing pediatric rehabilitation therapists. Claire Heffron is an OT, Lauren Drobnjak is a PT, and they both have extensive experience in school-based settings. The Inspired Treehouse is their joint effort to create child development resources for parents, teachers, and healthcare professionals. The blog covers topics like improving visual motor skills, advice for teletherapy, and fun seasonal crafts.   

Speech-Language Pathology Blogs

Pediatric speech-language pathology slp blogs to follow.

The Dabbling Speechie 

Felice Clark is a speech pathologist working in a pre-K to 5th-grade setting. Her blog is a great resource for helping school-age patients have fun while reaching their speech and language goals. The Dabbling Speechie has a wealth of creative ideas, including functional crafts, seasonal therapy activities, and engaging lessons. Felice is very passionate about the value SLP professionals can offer their patients, which also her makes her blog a highly motivational read.    

Speech Time Fun  

Hallie Sherman’s blog is brimming with practical tips for working with older speech therapy students. The current focus on Speech Time Fun is making the most of remote SLP sessions by using virtual resources. Recent posts have highlighted how to incorporate digital tools like Kahoot and Jamboard to practice language skills. Hallie also shares valuable content on her podcast and YouTube channel.    

Anna Dee SLP 

This excellent blog is a must-read for SLP professionals that work with toddlers and preschoolers. Anna Dee is passionate about the value of natural, play-based therapy for early intervention treatments. Her blog has detailed posts on enriching activities that kids really enjoy, including the use of toys, stories, and digital. Anna Dee SLP also specializes in actionable advice for helping patients with childhood apraxia of speech.  

The Speech Bubble SLP 

Maureen Wilson is a school-based SPL with down-to-earth advice to on handling the challenges of the job. Her blog manages to be both conversational and very substantive. A recent post offers thoughtful analysis of the research behind literacy-based speech therapy, as well as concrete examples of how to incorporate this technique. The Speech Bubble SLP also highlights activities, many books, toys, and games that are designed to encourage language skills. 

More Resources from Fusion Web Clinic

There’s always so much to learn in the world of rehabilitation therapy. Fusion Web Clinic offers many powerful tools and resources to help you optimize your practice and help patients more efficiently. Check out our resource library or schedule a demo to learn more about how our practice management software can help you streamline your workflow. 

Revenue Cycle Management (or RCM) is no small undertaking. The process of creating and submitting claims to insurance companies is complicated, let alone the fact that a good portion of insurance claims are denied requiring more detail or better data for payment. After all, even if you’re seeing a great number of patients, your clinic may be struggling financially because of an ineffective revenue cycle. Meaning you’re not getting paid what and when you should be.  

On a path with so many steppingstones like RCM, it’s easy for revenue to get lost along the way. With an understanding of the different steps of the revenue cycle for Speech, Occupational and Physical Therapy, you can be better prepared to create a more profitable organization. 

Insurance claims are a critical part of the healthcare revenue cycle.
Insurance claims are a critical part of the healthcare revenue cycle for OT, PT, and SLPs.

The Steps of the Revenue Cycle 

1. Payment Policies 

Effective Revenue Cycle Management begins before any patients schedule appointments. It’s important to sit down as a provider or practitioner and draw up payment policies. These not only help you communicate with patients but can act as a roadmap for accepting payments. Determine what kinds of payment you will accept and how you will accept it. Don’t forget to lay out how long self-pay patients will have to pay and the consequences of nonpayment. Also consider how you will work with HSAs and what will happen if a client misses an appointment.  

2. Benefits Checking 

Once appointments are made, or ideally, as part of the appointment process, you should check the patient’s eligibility and insurance coverage. Doing so before any treatment takes place can prevent surprises down the line and help patients and caregivers better understand any cost sharing responsibilities they may have, reducing nonpayment.  

Determine the patient’s primary and secondary insurance status and coverage before submitting claims. It’s also a good idea to make a copy of your patient’s insurance card and keep it on file in case you need to reference it later. 

A health insurance card for a physical therapy client that will come in handy during the healthcare revenue cycle.
Taking a copy of a client’s health insurance card should be on every provider’s intake checklist. 

3. Charge Creation and Coding 

Alright, so you’ve created a payment policy, verified coverage, and started with treatment. Time to bill. Here’s where it gets tricky.  

As physical therapy professionals, your mission is to treat clients and bring healing into their lives. But running a clinic involves income and creating charges for services rendered. This process is not so easy to manage, especially with constantly changing billing codes and regulations. In fact, issues with coding are a common reason claims are rejected. Also, watch out for under or over coding, creating a claim that doesn’t match up with the care provided.  

Ultimately, understanding what could cause a claim denial can better inform your charge creation. This will help get money back into your accounts by reducing the number of denied claims and making sure you don’t accidentally sell yourself short to insurance payers.  

4. Reviewing and Submitting Claims 

Before you submit claims, make sure you know the W’s of claim submission for each payer. Who, when, where, and how. Double check your claims before submitting. Remember that copy of the patient’s insurance card? It’s worth giving it another quick look. Make sure no information has been accidently left out or there are any of the coding errors like we talked about before.  

EHRs equipped with PT, OT, and SLP billing may be able to enlist a clearinghouse to review or scrub claims before submitting to make sure they aren’t missing key information or contain obvious errors and are less likely to be denied. They do say you should measure twice and cut once. The same goes for insurance claims. 

5. Status Reporting, Payment & Denial Management 

At this point, the claim has been submitted on time and as accurately as possible. Now, we wait. Make sure to check on the status of your submitted claims. If they are approved with no problems, great, but you still need to follow up to make sure the payment ends up in your account. An EHR with claim status reporting is a great way to keep an eye on claim progress.  

Let’s say a claim is denied. It’s important to act quickly to correct and re-submit the revised claim. The more delays that occur in the claim management process, the longer it takes for you to see the funds in your cash flow. Thankfully, the insurance company can provide remittance advice – their reasoning for why the claim was denied.  

If you’re able to submit claims electronically through your PMS or a clearinghouse, ask if you’ll be able to receive Electronic Remittance Advice (ERA) as ERA could save you even more time. With the notes you need to revise your claim delivered instantly, you can get revised claims resubmitted ASAP rather than having to wait for the mail.  

Get Help Managing Your Healthcare Revenue Cycle 

And so, the cycle of follow-up continues until all claims are reflected in your account. And, hopefully, if you’re seeing a steady stream of patients, this process is never-ending.  

As you’ve seen, there’s a lot of moving parts involved in building an effective revenue cycle. Just thinking of all that needs to be done to make sure claims are properly submitted can give someone a headache. A key takeaway? Let your EHR handle it.  

Trusting your EHR with your billing means your staff are freed up to focus on other initiatives. At every point in the billing process, your EHR’s billing services are taking small loads off your staff’s shoulders. And those small assistances add up. Claim submission, denial management, and following up on stuck claims are key functions where outsourcing billing through your EHR can add value. In addition, with a team of experts at your back, you won’t have to train additional billers to meet demands.  

Have Everything All in One Place 

You already trust an EHR with so many aspects of your practice. By enlisting your EHR’s billing services, you’re bringing all your patient care to one accessible log-in. If you’re ready to take your billing to the next level, find an EHR that can help. Fusion’s RCM services through our Assisted Billing solution are designed to help OTs, PTs, and SLPs get more out of the dollars and cents of their business. Schedule a demo of Assisted Billing today.  

Payment processing can be one of the most important parts of your revenue cycle—it’s also one of the most variable parts. Your organization’s patients may make their payment with HSA or FSA debit cards, credit cards, or a combination of different sources. As telemedicine grows, your patients may also be used to paying through online portals. Accounting for all of these different payment methods and pathways should be a top finance priority for your organization. But how does payment processing work? Let’s explore how credit card payments work for therapy practices and the benefits they bring.  

How does payment processing work? The parent of a pediatric physical therapy patient ready to pay for appointment and treatments with a credit card.
Understanding how credit card processing works can help your organization make the most of this feature. 

How Does Payment Processing Work? 

Most of credit card processing happen behind the scenes. Your patients and office staff ensure the billing details are correct and the payment method is entered, and then the amount appears in your account after two or three days. But knowing the steps in the middle can protect your organization. There are three main steps in credit card processing: authorization, settlement, and funding: 

Card Authorizing 

This process is nearly instantaneous. 

Settlement and Funding 

This process takes longer. But modern technology is speeding up the process so many payment processing tools can complete the process within 24 hours. 

Benefits of Credit Card Processing 

While there are many variables in collecting revenue that your organization can’t control, a better payment processing platform can give you the insight and internal organization you need to track payments and streamline payment for better cash flow. At Fusion, our payment processing platform is built to fulfill the unique needs of therapy practices by offering these solutions: 

How Does Payment Processing Work Once You Choose Fusion? 

Through our system, you can maintain accurate records of in-progress and completed payments. Your team can also manage billing and repeat invoicing through a single platform, which reduces miscommunication and delays.  

Fusion integrates with your patient records so you can invoice the correct parties, whether the charge is to a patient or a caregiver, through their preferred payment method. This streamlines the process and reduces potential delays caused by charging the wrong party or charging the wrong partial amounts to different parties. Contact us today to learn more about how our payment processing solution can integrate into your practice’s administrative infrastructure. 

In 2020, telehealth took a giant leap from an emerging practice to an integral part of the healthcare industry. Though remote pediatric occupational therapy (OT) has been around for several years, teletherapy strengthened its roots and helped it become a more sophisticated solution. While it may seem that clinic-based sessions would be more effective, telehealth gives new opportunities to families with barriers to traditional therapy models. According to studies, pediatric telehealth has a high patient satisfaction rate when done correctly. Here are 7 best practices to pediatric occupational therapy via telehealth.  

A pediatric occupational therapist, physical therapist, speech therapist (SLP) using telehealth to work with her clients.
Female medical professional speaking with a patient via video call during the COVID-19 health crisis from her office.

1. Work with the Right Tools 

High-quality software is the key to smooth patient-therapist interaction during a pediatric telehealth session. Even though pediatric OT relies heavily on parents, patients are involved as well. 

Children who need occupational therapy may experience challenges with poor video quality and sound delays. That’s why it’s imperative to invest in exceptional hardware, software, and video-conferencing tools. 

To make certain that therapy session proceeds smoothly, make sure your internet carrier provides a fast internet connection. Also, practice using new technology with the staff before starting telehealth sessions to minimize hiccups during show time.  

Look for telehealth solutions that are mobile-friendly and work together with other features in your EHR. This way, telehealth, payment processing, reporting and reminders can combine for the ultimate therapy toolbelt. 

For any software that you decide to use for your telehealth needs, you need to ensure patient data privacy to comply with: 

2. Streamline Documentation 

When it comes to pediatric telehealth, some therapists may work from the clinic and some may be working from home. Regardless, the documentation produced before and after each session must be organized and filed according to the clinic’s best practices. 

With a variety of practice management and EHR tools available, keeping documents in order shouldn’t be a problem. By filing information electronically, it’s possible to keep it secure while having access to it anytime and from anywhere. 

3. Provide Pediatric Telehealth Training for Parents 

When any clinic implements pediatric OT telehealth, it needs to be easily accessible for and easily understood by patients’ and parents. While your team may have solid experience with telemedicine, many patients don’t. 

Besides learning how to take full advantage of telehealth, parents need to understand how to help their children with the technology. Implementing training and support documents (e.g. FAQ) can help improve the experience for patients, their parents, and staff. 

It’s also important to provide special training to therapists who don’t usually practice telemedicine. With this knowledge, they can take on telehealth duties during peak demand times (like the COVID-19 pandemic). Well-trained patients and staff improve the cost-effectiveness and efficiency of teletherapy sessions. 

A mother helping her child on the computer before her pediatric telehealth session.
Helping parents become competent in telehealth can ultimately improve the quality of teletherapy sessions with your patients. 

4. Use the Available Resources 

Whether you are newly implementing telemedicine for your pediatric OT services or have had it in place for a while, your clinic can benefit from using the following resources: 

You should also explore regulations (both federal and local) related to security, licensure, and billing. 

Many of these resources can serve as guidelines for your telemedicine efforts. However, each clinic eventually sets up its own pediatric telehealth structure and best practices. 

5. Learn about Reimbursements  

Even though telehealth reimbursement is becoming easier, some healthcare providers are still having trouble getting reimbursed for their services. To make sure you are paid for your pediatric telehealth services, it’s imperative to have a strong billing system in place. Simple errors made when filing claims with insurance companies could lead to denials, rejections, and time-consuming appeals. 

Many clinics struggle with telehealth coding because staying up to date with the latest changes and requirements can be complicated. Having a strong grip on the process of revenue cycle management (RCM) is imperative to avoid claim denials and getting reimbursements on time.  

So, when it comes to telehealth billing, it’s a great idea to employ an EHR like Fusion which can help you with revenue cycle management. For example, Fusion allows you to outsource billing and RCM to dedicated specialists and the service works perfectly in tandem with the other EHR capabilities like telehealth.  

6. Market Your Services 

Parents who are looking for pediatric occupational therapy options often don’t know that it’s possible to work with a therapist on a remote basis. That’s why clinics need to make and extra effort to promote these services and educate patients about telemedicine opportunities. 

Since telehealth makes it possible to help children remotely, you now have the ability to widen your marketing efforts to attract a wider audience that may not have been able to work with you in the past.  

Even though telemedicine isn’t new, many patients, especially parents, are still cautious about taking full advantage of it. It’s up to clinics to educate them about telehealth possibilities for pediatric occupational therapy. 

7. Ask for Feedback 

No matter how hard you try to implement a stellar pediatric telehealth service, it’s always possible to overlook some details. By asking families for feedback, you can learn how to adjust your telemedicine program, thus improving your clinic’s profitability. 

Besides listening to your patients’ comments, make sure to ask for the staff’s feedback as well. It can help you gain valuable insight and make the program better for all parties involved. 

Improve Your Pediatric Telehealth Services Today  

Using telemedicine for pediatric OT can help your patients get the necessary therapy on time regardless of their ability to visit the office. Meanwhile, the right approach to pediatric telehealth can help you streamline your services and improve the clinic’s bottom line. 

Implementing and maintaining a telehealth program is impossible without the right tools. At Fusion, we have a set of powerful solutions for clinics that offer pediatric OT telehealth services. To learn more, contact us today for a free live demo.   

You don’t have to be a pro athlete to know there are two primary components to training for a sport. First, there’s a daily regimen of exercises designed to condition and strengthen the muscles, providing a strong foundation. Second is an extensive amount of practice with the specific movements the game requires. This analogy can help us make sense of when to use each of the two most common occupational therapy CPT codes: 97110 and 97530.  

The 97110 CPT code describes therapeutic exercises that a patient participates in during an OT therapy session. These exercises help build strength or endurance to support a return to normal functioning. The 97530 CPT code describes therapeutic activities that are practiced during a session to improve functioning. These activities often include practicing real-life skills like transferring from a chair or bed. In this post, we’ll examine both codes in-depth, explain when to use them, and identify the billing documentation needed for each.

What is the 97110 CPT Code?

The 97110 CPT code describes foundational occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility. They address issues with muscle weakness, stiffness, or a decreased range of motion. 

In order to bill, the exercises prescribed must be medically necessary to improve a patient’s strength and mobility to increase participation in activities of daily living, like bathing, dressing, feeding, and a range of other functional activities. You work with the client to complete these exercises, either actively, active-assisted, or passively. Another requirement to bill using the 97110 CPT code is that you must be actively working with the client one-on-one during the entire session. It’s a timed code, with each unit lasting 15 minutes. The 97110 CPT code describes exercises that address one deficit area across one or more areas of the body.

Read Understanding Occupational Therapy Billing Units to learn how to calculate billing units for timed codes.

When to Use the 97110 CPT Code

You’ll use this code when you’re working with a patient to complete sets of specially designed exercises that restore flexibility, strength, endurance, or range of motion. Examples of exercises that would typically carry this billing code include using free weights to increase arm strength or walking on a treadmill to build endurance. Other examples may include overhead stretches with a TheraBand to increase range of motion in an injured shoulder or using TheraPutty to build up hand strength after a stroke.

Required Documentation for the 97110 CPT Code

Documentation helps you provide better care to clients and, importantly for billing, justifies your services to insurers if you receive a claims rejection or undergo an audit. The documentation for billing 97110 typically identifies a single deficit area you’re targeting for treatment. It makes a clear connection as to how that deficit is negatively impacting the patient’s quality of life. Decreases in flexibility, range of motion, strength, and endurance are all examples of commonly used deficit areas. 

You should record an objective measure of the deficit area before beginning to work with the patient and update it as they progress through the course of treatment. Your documentation should include the area of the body you’re working on and the type, quantity, and purpose of exercises performed during your occupational therapy sessions. 

As the patient progresses, document any changes you made to their exercise program, including any new exercises added. You’ll want to clearly show that the client is making objective, measurable improvements and that there is a clear, planned progression towards an eventual transition to a home exercise program. For complex patients who require a higher level of care, billing for more than one unit can certainly be appropriate.

What is the CPT 97530 CPT Code?

The 97530 CPT code is used to document therapeutic activities intended to improve a patient’s functional performance due to lost or restricted mobility, coordination, balance, flexibility, or strength. What differentiates the 97530 CPT code from the 97110 CPT code is that it involves functional activities, not exercises. These activities provide very specific training for the activities of daily life that have been compromised. To use this code, you must be present with the patient for the entire session, working one-on-one with them in an active, active-assisted, or passive role. The 97530 CPT code is also a timed code, with each unit lasting 15 minutes, and it describes a therapy session that addresses multiple deficits through participation in a functional activity. 

When to Use the 97530 CPT Code

The 97530 CPT code is often the best choice when the session focuses on training that involves a functional activity. One example would include having a patient stand on a balance board while bending down or reaching up for objects at varying heights. Another might include having a client complete a fine motor task while they’re wearing cuff weights. 

Required Documentation for the 97530 CPT Code

Where the 97110 CPT code typically addresses just one deficit area being targeted by treatment, the 97530 CPT code most frequently focuses on two or more areas. These expected outcomes include things like improving balance, flexibility, strength, or other functional activities. Your documentation should include the areas you targeted for improvement and a detailed description of those activities. Explain why you chose these activities to remediate the deficit areas. Make a clear connection between the activity and its role in restoring a function of daily life. Include the level of assistance you needed to provide the patient during the activity. 

Read SOAP Notes for Occupational Therapy to take better documentation notes and speed up your process. 

Wrapping Up

At first glance, the 97110 and 97530 CPT codes look very much alike. Although they have similarities, there are some significant differences in how the occupational therapy is provided and the documentation required for each. Knowing when and how to use each will decrease your number of rejected claims and can simplify potential audits from insurers.

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.

Occupational therapy evaluation codes are divided into three tiers based on complexity: low, moderate, and high. The complexity level of an evaluation is based on three areas: the patient’s profile and history, the assessment of occupational performance, and level of clinical decision making exercised by the occupational therapist during the evaluation. While this categorization seems straightforward, it can be challenging to know what constitutes low complexity, moderate complexity, and high complexity. In this post, we’ll walk through what to look for at each level to help you discern which CPT evaluation code best matches the service you performed. We’ll also cover the code for an occupational therapy reevaluation and its criteria. As we close out, we’ll look at three mistakes commonly made with occupational therapy evaluation billing codes.

What to Consider as You’re Choosing Evaluation Codes for Occupational Therapy

As we discuss each evaluation code, we’ll begin with the exact verbiage from the CPT Code Manual. From there, we’ll share practical markers to look for at each level of complexity. It’s important to note that to select the correct level of complexity, you must be sure all three areas meet the criteria for that evaluation level. For example, if an evaluation met the definition of a low level of complexity for both profile and history and assessment of occupational performance components, but the level of clinical decision-making was done at a moderate level, you would still be required to bill at a low level of complexity. 

Low Complexity Evaluation (OT 97165)

A low complexity evaluation takes the least amount of time and involves a relatively uncomplicated process of reviewing, evaluating, and creating a plan of care. Here’s the exact definition as found in the CPT Code Manual.

 

Occupational therapy evaluation, low complexity, requiring these components: 

 

  • An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; 
  • An assessment(s) that identifies 1-3 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
  • Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component.
  • Typically, 30 minutes are spent face-to-face with the patient and/or family.

Defining Characteristics of a Low Complexity Evaluation

Determining the correct type of occupational therapy evaluation requires sound professional judgment. While there’s no one-size-fits-all definition of what constitutes a low complexity evaluation, here’s a description you can judge by.

 

A low complexity evaluation begins with a brief review of the patient’s medical and/or therapy records related to the presenting problems. There are no comorbidities that impact the presenting problem. In this evaluation, you would use standardized assessments to identify up to three deficits in functional performance that result in the patient’s activities or participation being limited or restricted. The patient does not require modifications or assistance to complete the assessments. Performance deficits may be in the physical, cognitive, or psychosocial areas. When considering your menu of treatment options, you would include an analysis of the occupational profile and data from problem-driven assessments. A low level of analytical skills is required during this type of evaluation. 

Moderate Complexity Evaluation (OT 97166)

An occupational therapy evaluation of moderate complexity is a mid-tier evaluation. According to the CPT Code Manual, an evaluation of moderate complexity needs to include the following characteristics. 

Occupational therapy evaluation, moderate complexity, requiring these components: 

  • An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance;
  • An assessment(s) that identifies 3-5 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and 
  • Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. 
  • Typically, 45 minutes are spent face-to-face with the patient and/or family.

Defining Characteristics of a Moderate Complexity Evaluation

During a moderate complexity evaluation, you would begin with a more in-depth review of the patient’s medical and/or therapy records. You would also complete a secondary review of the patient’s relevant physical, cognitive, and psychosocial history. The patient may have comorbidities affecting their occupational performance. Using standardized assessments, you would identify three to five deficits in the areas of physical, cognitive, or psychosocial ability. The patient may require minor to moderate modifications or assistance when completing the assessments. Performance deficits may be in the physical, cognitive, or psychosocial areas. You may develop an expanded range of treatment options using the occupational profile and data from problem-driven assessments. Analytical skills are exercised at a moderate level.

High Complexity Evaluation (OT 97167)

An evaluation at the highest level of complexity is typically done with a patient exhibiting multiple impairments and complex medical history. The CPT Code Manual states an evaluation of high complexity must satisfy each of the criteria listed below.

Occupational therapy evaluation, high complexity, requiring these components: 

  • An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; 
  • An assessment(s) that identify 5 or more performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and
  • A clinical decision-making is of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component.
  • Typically, 60 minutes are spent face-to-face with the patient and/or family.

Defining Characteristics of a High Complexity Evaluation

During a high complexity evaluation, you would conduct an in-depth review of the patient’s medical and/or therapy records, including a thorough review of the patient’s relevant physical, cognitive, and psychosocial history. The patient has comorbidities that are impacting occupational performance. Using standardized assessments, you would identify five or more physical, cognitive, or psychosocial performance deficits. The patient requires a significant level of modifications or assistance to complete the assessments. Performance deficits may be in the physical, cognitive, or psychosocial areas. Extensive data from various sources, including the patient’s occupational profile and a range of problem-focused assessments, requires a high level of analytical skills to develop several treatment options.

Reevaluation (OT 97168)

Unlike the three-tiered system of occupational therapy evaluation codes, the reevaluation is just a single code. Compared with the evaluation codes, the criteria found in the CPT Code Manual are relatively simple.

Reevaluation of occupational therapy established plan of care, requiring these components:

  • An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and
  • A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. 
  • Typically, 30 minutes are spent face-to-face with the patient and/or family.

Defining Characteristics of a Reevaluation

The reevaluation isn’t broken down into levels of complexity like the evaluations are. A reevaluation is typically conducted when there is a new clinical finding, a substantial change in the patient’s functioning, or when the patient is not responding to the current therapeutic interventions. 

Common Mistakes with Occupational Therapy Evaluation Coding

When billing for occupational therapy evaluations, it’s easy to make mistakes. Incorrectly coding the complexity level of an evaluation can result in your claim being denied, and having to make the necessary corrections and resubmit the claim wastes time and can delay your reimbursements. So you’ll want to avoid mistakes when possible. Here are three of the most frequently made occupational therapy billing mistakes.

  • Undercoding — If you’re not thoroughly familiar with the criteria for each level of occupational therapy evaluation, you may inadvertently be undercharging for services you’ve performed. Knowingly undercoding isn’t a way to protect your practice from audits, and it’s actually considered unethical.
  • Overcoding — On the flip side, overcoding puts you at risk of an insurer denying your claim if the level of evaluation you’re claiming seems excessive. Remember, each of the three main areas of the evaluation must meet the criteria for the highest level of evaluation you’re claiming.
  • Incomplete Documentation — If an insurer challenges one of your billing claims or if your practice is audited, having documentation to back up the level of service you’re claiming is essential. Your therapy notes must be able to objectively prove that you provided the service you’re billing for.

In Conclusion

Billing an insurer for a higher level of complexity than your documentation can support may result in a billing claim being rejected. Choosing a code that’s at a lower complexity than you actually performed will result in being underpaid for your services. By understanding the CPT code descriptions, you’ll be able to bill with confidence, knowing you’re getting properly compensated and can back up your claim with sound reasoning.

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.

Because there are many different occupational therapy ICD-10 codes, some of which are quite similar, it can be challenging to know which to use when assessing and treating patients. This post will explore the common mistakes to avoid when assigning ICD-10 codes and tips for selecting the most accurate code for billing purposes. We’ll close with a list of common ICD-10 codes that occupational therapists use most frequently.

What is ICD-10 Coding?

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. This framework is the World Health Organization’s medical and therapeutic classification system. It’s a standardized system that allows medical and therapy professionals to code a wide variety of diseases, external causes of injury, treatment of conditions, and more.

 

The United States was the last country with a modernized health care system to adopt ICD-10 coding standards. On October 1, 2015, the U.S. officially moved away from ICD-9, the older code set that had been in use since 1979. The use of ICD-10 is now mandatory for all entities covered under HIPAA.

ICD-10 codes are a combination of three to seven alphanumeric characters. There are two types of ICD-10 codes: medical diagnosis codes and treatment diagnosis codes. The patient’s physician assigns medical diagnosis codes. A therapist can assign treatment diagnosis codes. ICD-10 codes don’t replace CPT codes — it’s important to note that you much include them both on billing claim forms.

Common ICD-10 Coding Mistakes

The move to ICD-10 was a double-edged sword for occupational therapists. The new code set contains over five-and-a-half times more codes than its predecessor. More specific codes allow you to select the code that accurately and clearly describes a patient’s current deficit area. But with more similar-but-slightly-different codes available, the chances of incorrectly coding a treatment diagnosis have increased. Here are some of the most common ICD-10 coding mistakes and how to avoid them.

1. Using Outdated Codes

ICD-9 was replaced in 2015. Although it’s been several years, if you were familiar with the old way of coding, it may be easy to inadvertently revert to outdated codes, especially if you’re rushing or tired. If you use an old code, your chances of an insurer rejecting your billing claim are all but assured.

2. Confusing Similar Letters and Numbers

ICD-10 codes are made up of alternating series of letters and numbers, separated by periods. If you’re not paying close attention or are in a hurry, it’s easy to place an O where a zero should be or swap a 1 for an I. Accidentally subbing in the wrong letter or number in a coding sequence can change the therapeutic diagnosis code entirely, sending up a red flag to insurers as they process your claim.

3. Leaving Out Laterality and Specificity 

ICD-10  focuses heavily on identifying the laterality and coding to the highest specificity. This focus can make finding the best code a little more time-consuming. But finding the code that’s the best fit for the therapeutic diagnosis and designates which side of the body is affected will help you avoid rejections or denials.

4. Selecting an Incorrect Code 

Lack of familiarity with the full menu of ICD-10 codes that could describe a particular diagnosis can result in choosing the wrong code. You don’t have to know them all, but being well-versed in the codes most frequently used with occupational therapy patients can help avoid time-consuming resubmissions.

5. Incomplete Documentation  

If you enter a treatment diagnosis code, you need to have documentation to justify your choice. Keeping detailed notes of your therapy sessions and recording data from objective assessments of their current levels of functioning makes it easier to justify your choice if it’s ever challenged by an insurer.

Tips for Choosing the Best ICD-10 Code for Occupational Therapy

When you choose the wrong ICD-10 code, incorrect information about a patient goes on the record, making it difficult to show the medical necessity of the treatment you provided. This can lead to billing claims rejections, time-consuming resubmission, and payment delays. Here are some helpful tips to ensure you choose the best ICD-10 code for every patient the first time.

Begin with Documentation 

Assess your patient’s impairments using objective measures and document their current level of functioning in the area you’ll be providing service. Create and document your short and long-term goals for the patient related to the targeted impairment and include them as part of the patient’s plan of care. Select your treatment codes, consulting the code definitions to ensure they match up with the impairment.

Be Sure Treatment is Medically Necessary for the Diagnosis

The code you choose must be medically necessary and directly relate to the service you provided to the patient.

Use Therapy Notes to Support Your ICD-10 Code Choice

Documentation from your therapy notes should support your ICD-10 coding choice. Include information such as dominant side, anatomical details, site specificity, and the affected body part.

Order the Codes by Amount and Complexity of Care

As mentioned before, code to the highest level of specificity, including all of the patient’s current medical conditions and comorbidities related to the current therapy services you’re providing. Order the codes sequentially by the amount and complexity of therapy being provided.

Use Unspecified Codes Sparingly 

There’s certainly a place for using unspecified codes if there’s insufficient information in the patient’s medical record. But unspecified codes tend to get overused in favor of less common, but more specific codes. Using an unspecified code too often can be a red flag for insurers.

Commonly-Used OT ICD-10 Codes

Some ICD-10 codes are more commonly used by occupational therapists than others. Here are ten codes you’re likely to come back to again and again.

Wrapping Up

ICD-10 is the most comprehensive diagnostic coding system to date. It gives occupational therapists the freedom to select diagnostic codes that include a high level of detail about their patient’s condition. But with expanded choices comes an increased risk for coding mistakes. By paying careful attention, becoming familiar with the codes most often used by occupational therapists, and keeping good documentation, you’ll be able to avoid many of the common ICD-10 coding pitfalls.

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.

To err is human. But making errors on your claims forms can result in delayed or denied reimbursements. From clerical mistakes to inaccurate coding, there are many ways that billing trips up therapists handling their own claims. This post will explore some of the most common mistakes in occupational therapy billing and share how to avoid them so you can improve your acceptance rate and get paid faster.

General Errors in Occupational Therapy Billing

General billing errors are the easiest to avoid. You can prevent these errors by paying close attention to the information you record on your patient data, claims forms, and therapy notes. 

Clerical Errors

Incorrectly spelling a patient’s name or entering the wrong date of birth significantly raises the chances of an insurance claim rejection. Simple mistakes like entering the incorrect insurance provider details can be time-consuming to fix. Rushing through the claims submission process rarely saves time in the long run. 

Duplicate Billing 

If two staff members file a claim, both claims will likely be rejected. Make sure everyone is on the same page about who’s responsible for filing claims. Having a clear division of labor in your office will help prevent this error. 

Insufficient Documentation

Insurers want proof that you’re providing the services you’re billing for. Your claims form should include the patient’s diagnosis with their presenting problems and the services you provided. If you’re asked to provide documentation describing your reasoning for choosing the treatment, you’ll need to be able to present it.

Did you know you can sometimes bill for the time you spend doing documentation? Learn more by reading When Can Pediatric Therapists Bill for Documentation Time?

Coding Errors in Occupational Therapy Billing

CPT codes are the language of insurance billing. When you use an incorrect code, the intended message gets lost in translation. Let’s examine some of the most common CPT coding missteps.

Upcoding or Undercoding

Upcoding is coding for a higher-paying treatment than was actually performed. Undercoding is the opposite — it involves coding for a lower-paying treatment than you delivered. Upcoding can be used to generate higher payments from insurers. While it may be an innocent mistake, insurers take it seriously. Intentional undercoding is sometimes used to avoid audit scrutiny or to save a patient money. Both practices are unethical.

Using an Incorrect CPT Code

With so many CPT codes to choose from, it’s easy to select the wrong one. Using an incorrect CPT code exponentially increases your chances of a claims rejection or denial. Even if your billing claim is paid, incorrect information may become part of your patient’s billing record, so it’s important to avoid incorrect codes. 

Incorrect Use of Modifiers

Billing modifiers supply additional information about the type of service that you performed. Modifier 59 is one of the most commonly used. This code indicates that two services that would typically be billed together were provided independently and should be reimbursed as separate interventions. If you use a billing modifier, make sure the services provided match the modifier’s intended use. 

Unbundling Codes

Unbundling involves billing for two services separately that are usually billed together as a bundled service. In most instances, bundled codes must be used for a combination of services performed in the same session, rather than coding the services separately. 

Overusing Codes

Overreliance on a single CPT code is a red flag to insurers, and rightly so. In any occupational therapy practice, therapists provide a broad menu of services. It may be tempting to reach for your old standby, but locating the CPT code that best represents the diagnosis or intervention you provided is always the right choice.

Exceeding the Capped Daily Maximum for Fixed Rate Payers

Fixed rate payers like Medicare have a capped daily maximum payment. If you provide services that exceed this amount, you won’t be paid for any services you rendered beyond the maximum. 

Undertiming a Therapy Session 

Keeping accurate records of how long you spent in a session ensures you’re able to bill for timed codes accurately. Guesstimating can result in billing for one unit rather than the two you were entitled to. Gradually, the cost of undertiming sessions will add up.

Not Coding for Telehealth-Based Services 

Telehealth-based services have experienced a rapid expansion in 2020. Some insurers require the use of a CPT modifier when billing for services provided via telehealth. As a general rule, Medicare providers and private insurers require the 95 modifier to indicate the service was provided via telehealth. 

How to Avoid Coding Errors

The good news about billing errors is that they’re avoidable. The time you spend tightening up your practice’s billing procedures and building a deeper knowledge of billing-related issues will pay off many times over. Here are three best practices that will help you prevent errors.

  • Train Your Staff — The importance of a well-trained staff cannot be overestimated. Periodic training for office staff responsible for billing helps to calibrate everyone’s efforts and makes it easier to correct potential issues quickly. 
  • Stay Current on CPT Codes — CPT codes and the guidelines that govern their use change frequently. Keeping up with what’s new ensures your billing claims use the most up-to-date information.
  • Look for Patterns in Claims Rejections and Denials — Claims rejections and denials happen to even the most careful billers. Look for common reasons why your office’s claims are rejected or denied. They may vary by insurer, so pay close attention to any themes you see. Recognizing patterns can help you right the ship quickly.

Use Software Technology to Avoid Errors

Occupational therapy billing is a complex process, and it’s easy to make mistakes. But because coding correctly the first time is essential for prompt payment, you’ll want to ensure you avoid errors. Using a good practice management software that automates much of the process will help. With software, you can store information digitally and auto-populate your claims forms. You can also see an updated list of codes that apply to your services.

See how Fusion’s practice management system can help you improve your claims acceptance rate. 

Check out our Complete Guide to Occupational Therapy Billing to learn more about how to simplify and improve your billing processes.

While billing can be intimidating if you’re new to it, there’s no reason to fear handling your own billing. Being your own biller gives you complete flexibility and allows you to control the entire client-practice relationship. You can also ensure compliance more easily since you’re aware of everything that’s being done. 

This guide explores the essentials you need to know about occupational therapy billing practices. We’ll cover the most common billing errors and how to avoid them. We’ll then take a deep dive into occupational therapy evaluation CPT codes and the criteria required to bill for each. We’ll wrap things up with a look at best practice tips for selecting the right ICD-10 codes.

Common OT Billing Mistakes

Errors with occupational therapy billing can be costly. When claims are rejected, payment for services is delayed, robbing your practice of the operating capital it needs to thrive. Mistakes with coding can also result in incorrect information being added to a client’s billing record, being paid less compensation than you’re owed, or being flagged for an audit by an insurer. Here are some of the most frequently-made billing mistakes and how to steer clear of them.

General Errors and How to Avoid Them

Mistakes in this category are usually a result of carelessness, and they’re easy to avoid. 

  • Clerical Mistakes — Misspelling a client’s name, entering an incorrect date of birth, or transposing a number or letter in the patient’s policy ID number are all examples of clerical errors. These honest mistakes are a hassle to correct and often result in payment delays. Slowing down enough to fill out and submit a billing claims form correctly the first time is always a time-saver.
  • Double Billing — Submitting the same claim twice all but guarantees a claim will be rejected. Delineate billing responsibilities in your office, so there’s no confusion about who’s submitting claims for reimbursement.
  • Missing Documentation — If you don’t include adequate information, you may be asked to resubmit the claim. Including all the information required on the initial claims form will reduce rejections and denials.

Coding Errors and How to Avoid Them

Coding mistakes are more difficult to prevent since they’re usually a result of not understanding the OT CPT codes. But you can use best practices to avoid them.

  • Upcoding — As the name implies, upcoding involves using a billing code that exceeds the patient’s current diagnosis or the level of treatment you provided. At times, upcoding can be the result of misunderstanding the criteria for billing that code. Reading the CPT code description found in the CPT Code Manual can increase the accuracy of your coding. Upcoding is illegal, so getting this right is essential. 
  • Undercoding — The opposite of upcoding, undercoding is reporting a diagnosis or procedure that’s less intensive than reality dictates. Undercoding can result from an honest mistake or an attempt to save a patient some money or avoid an audit. Undercoding is not ethical, so be sure you’re accurately billing at the patient’s actual level of need.
  • Overusing Codes — When it comes to billing, there’s no lack of CPT codes to choose from. It can be tempting to use the same codes over and over again for convenience. But this practice may invite an audit from an insurer and doesn’t provide an accurate reflection of the services you’re delivering. 
  • Not Including Telehealth Modifiers — Providing telehealth services often requires the use of a modifier. Medicare and private payers typically want therapists to include the 95 modifier to indicate a service was provided via telehealth.

See Common Mistakes in Occupational Therapists Make When Billing for more mistakes and how to avoid them. 

OT Evaluation CPT Codes

Occupational therapy evaluation codes are broken into three tiers based on the level of complexity. Each one has a corresponding CPT code. An occupational therapy reevaluation has a single CPT code. Below is a brief snapshot of what an evaluation at each level would typically involve. 

Low Complexity Evaluation (OT 97165)

  • This evaluation requires only a brief review of the patient’s medical and/or therapy records related to the current presenting problem.
  • The patient has no comorbidities impacting the presenting problem. 
  • The therapist identifies up to three deficits in functional performance that result in a patient’s activities being limited or participation restricted using problem-driven standardized assessments.
  • No modifications or assistance from the therapist are required to complete the assessments. 
  • Deficits in performance may be physical, cognitive, or psychosocial. 
  • Analysis of the patient’s occupational profile and data from assessments is used to formulate a small number of treatment options. 
  • The evaluation requires a low degree of analytical skills to complete. 

Medium Complexity Evaluation (OT 97166)

  • This evaluation requires an in-depth review of the patient’s medical and/or therapy records, including a secondary review of the patient’s relevant physical, cognitive, and psychosocial history. 
  • The patient may have comorbidities that impact their current level of occupational performance. 
  • The therapist identifies three to five deficits in the areas of physical, cognitive, or psychosocial ability using problem-driven standardized assessments. 
  • Minor to moderate modifications or assistance from the therapist may be required to complete the assessments. 
  • Deficits in performance may be physical, cognitive, or psychosocial. 
  • Analysis of the patient’s occupational profile and data from assessments is used to formulate an expanded range of treatment options. 
  • The evaluation requires a moderate degree of analytical skills to complete.

High Complexity Evaluation (OT 97167)

  • This evaluation requires an intensive review of the patient’s medical and/or therapy records, including a thorough examination of the patient’s relevant physical, cognitive, and psychosocial history. 
  • The patient has comorbidities that are impacting occupational performance. 
  • The therapist identifies five or more physical, cognitive, or psychosocial performance deficits using problem-driven standardized assessments. 
  • A significant level of modifications or assistance from the therapist is required to complete the assessments. 
  • Deficits in performance may be physical, cognitive, or psychosocial. 
  • Analysis of extensive data from various sources, including the patient’s occupational profile and assessments, is used to develop several treatment options.
  • The evaluation requires a  high degree of analytical skills to complete. 

Reevaluation (OT 97168)

The occupational therapy reevaluation is not a leveled system with multiple CPT codes to choose from. Instead, it relies on a single code. Most often, you’ll conduct a reevaluation when there’s been a marked change in a patient’s present level of functioning or they’re not responding to the current therapeutic interventions. A significant, new clinical finding may also trigger a reevaluation. 

For a full explanation of OT evaluation codes and how to choose the appropriate one, read Evaluation Codes for Occupational Therapy Billing.

The 97110 CPT Code

The 97110 CPT code is one of the most frequently-used therapeutic procedure codes for occupational therapy. Knowing when to use this code, the documentation you’ll need to back it up, and when to use the 97530 CPT code instead will save you from potential billing headaches down the road.

When to Use 97110

The 97110 CPT code describes foundational therapeutic exercises designed to improve a patient’s range of motion, strength, flexibility, or physical endurance. The goal of the exercises must be to restore the ability to perform an activity of daily life or other functional activity. Exercises that fit the 97110 CPT code typically target only one deficit area. Examples include using TheraPutty to increase finger strength or a treadmill to increase endurance when walking short distances.

Required Documentation for 97110

When keeping records of your sessions with patients, focus on clearly identifying the deficit area your exercises are targeting. Connect how a lack of strength or flexibility in a specific area of the body affects their ability to function in daily life. Specify the region of the body you’re working on and how the exercises you’ve prescribed are specifically designed to remediate the deficit area and restore the loss in bodily functioning. Start with an objective measure of the client’s current level of function and update it with periodic measurements that show consistent improvement over time.

When to Use 97530 CPT Code Instead

The 97530 CPT code is a very similar billing code, but it has some important distinctions. In some cases, this code may be a more accurate descriptor of your actual work with your patient. If your work with the patient focuses on activities designed to remediate multiple deficit areas rather than simply exercises that address a single deficit area, you’ll want to consider using the 97530 CPT code instead.

Read How and When to Use the 97110 CPT Code to learn more about the difference in codes 97110 and 97530.

What to Know About ICD-10 Coding

ICD-10 is a diagnostic tool developed by the World Health Organization. ICD-10 codes are used in the United States by medical and therapy professionals to document medical and treatment diagnosis. These codes must be included in insurance claim submissions along with related CPT codes.

Common ICD-10 Coding Mistakes

ICD-10 codes are highly specific, making it easier for therapists to select codes that describe the patient’s current impairment in greater detail. But many of these codes are quite similar, increasing your chances of incorrectly coding a diagnosis. Here are a few of the most common ICD-10 coding mistakes and how to avoid them.

1. Confusing Similar Letters and Numbers 

Each ICD-10 code is three to seven characters in length and is made up of alphanumeric characters. This structure makes it easy to make careless mistakes like placing an O where a zero should be or using a 1 instead of an I. Do a double-take on your ICD-10 codes to catch any obvious errors. 

2. Omitting Laterality and Specificity

Payers require identifying laterality and coding to the highest specificity. It may be tempting to use a more generic code, but taking the time to find the one that best describes your diagnosis will reduce rejections and denials. 

3. Using an Incorrect Code

Become familiar with the ICD-10 codes used most often with occupational therapy patients. Knowing the codes can help ensure you’re choosing the one that offers the most accurate portrayal of the patient’s presenting problem.

4. Incomplete Documentation

ICD-10 codes require documentation to back them up. Keeping detailed notes of your therapy sessions, recording data from objective assessments of a patient’s current functioning levels, and including specific details like site-specificity can help you justify your choice of a diagnosis code if it’s ever challenged. 

Tips for Choosing the Best OT ICD-10 Code

While it can sometimes be challenging to know which code is the best one for a patient, these three tips should help you. 

  • Support Your Coding Choice with Documentation — The notes that you keep from your sessions should support your ICD-10 coding choice. Objective measures of the patient’s impairment and short and long term goals from their plan of care should directly support the ICD-10 codes you’re using. Detailed information like dominant side, site-specificity, and the affected body part is valuable information to have handy in the event of a claims denial or audit.
  • Be Sure Treatment is Medically Necessary for the Diagnosis — The code you choose must be medically necessary and directly relate to the service you provided to the patient.
  • Avoid Unspecified Codes When Possible — Unspecified codes have their place in ICD-10 coding. There are certain instances where using one may be your only option. But because unspecified codes tend to be used as shortcuts, you’ll want to be sure you use them only if a specified code isn’t available.

For more on ICD-10 coding, read Top ICD 10 Codes for Occupational Therapy.

OT Practice Management Software Can Help Make Billing Easier

There are a lot of moving parts to occupational therapy billing. Using a good practice management software can help you prevent mistakes and streamline your process, speeding up reimbursements. Practice management software allows you to store information digitally and auto-populate your claims forms with details from your notes. It can also help ensure you’re using the best codes for your services. 

See how Fusion’s practice management system can help you improve your claims acceptance rate, and request a free demo today!

Goals inspire us and give us milestones to work toward. Writing effective pediatric occupational therapy goals is especially important for the success of your patients and your practice. Goals establish a structure for planning and tracking progress while providing ongoing motivation for both you and your patients. Having a set of established goals for each patient allows other professionals to work productively with your patient when you are out. And they speed up the reimbursement process by reducing the chance of your claim being rejected. Perhaps most importantly, effectively-written goals have been proven to improve patient outcomes. In this post, we’ll look at three formats for goal-writing and offer effective examples of pediatric occupational therapy goals.

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