Transcript Indiana New Payment System

New Payment System
Evaluation Codes
For Physical Therapy
A Step Toward Payment Reform
Coding Reform
Wiring & Plumbing for Payment Reform
Payment Reform for Rehab Services
•
2012 AMA formed PM&R Workgroup (WG) to address changing the reporting
methodology consistent with CMS and payment reform efforts
•
2013-2014 AMA PM&R WG continued it’s work focusing on evaluation codes as well
as intervention codes to continue to progress from reporting timed procedures to a
reporting methodology that describes severity/intensity
•
2015, February accomplished revision of evaluation codes to be published for 2017
Payment Reform for Rehab Services
2015
• RUC-Eval codes
–
–
April: surveyed evaluation codes through RUC process.
September: presented survey results to RUC for establishment of values to be considered by
CMS for 2017 Fee schedule
PM&R WG continued work on severity/intensity model for intervention
codes.
2016
•
•
•
Interventions on indefinite hold: our path forward will include efforts reflecting
input from association members and other stakeholders.
APTA is launching an educational campaign designed to help PTs comply with
reporting the new evaluation codes
CMS PROPOSAL for 2017
All three evaluation codes will be reimbursed at the same level.
• “…we do not believe that making different payment based on reported
complexity for these services is, at current, advantageous for Medicare or
Medicare beneficiaries.” (FR* 2016 p. 347)
• “…stratified payment rates may provide, in some cases, a payment
incentive to therapists to upcode…” (FR* 2016 p.345)
• CMS cannot predict “with a high degree of certainty” the utilization of the
different levels of evaluation codes to maintain budget neutrality.
*Federal Register
2017 Evaluation Codes for Physical Therapy
• Evaluation
97161
97162
97163
• Re-evaluation
97164
Low Complexity Evaluation
Moderate Complexity Evaluation
High Complexity Evaluation
A single code
Today, in 2016
•
97001 Physical Therapy Evaluation
•
97002 Physical Therapy Re-evaluation
 Published in 1998 and active CPT codes through 2016.
 This coding structure includes two “service based” codes
 Do NOT reflect any specific level of complexity or severity
Elements of a Physical Therapy Evaluation
• Examination (includes history, systems review, and tests and
measures)
• Evaluation (the thought process leading to identifying impairments,
functional limitations, disabilities, and needs for prevention)
• Diagnosis (impact of the condition on function)
• Prognosis (professional judgement regarding the predicted
functional outcome and the estimated duration of services required)
• Plan of Care (the culmination of an evaluation)
Why Are Evaluations So Important?
• The evaluation drives the care and/or management of the care
• A thorough and complete evaluation is critical to success in achieving a
positive outcome for the patient’s episode of physical therapy care
• A reflection of the level of complexity of the patient is key to effective
management throughout the episode
Physical Therapy Evaluation
A Physical Therapy Evaluation should clearly reflect:
•
•
MEDICAL NECESSITY for services to follow
Focus on FUNCTION
2017 Evaluation Codes for Physical Therapy
• Evaluation*
97161
97162
97163
• Re-evaluation*
97164
Low Complexity Evaluation
Moderate Complexity Evaluation
High Complexity Evaluation
A single code
* 97001 PT evaluation and 97002 PT Re-evaluation will be deleted from the code set.
2017 Evaluation Codes for Physical Therapy
• Stratify the patient population
• Move beyond diagnosis stratification
• Acknowledge that patients vary due to comorbidities and other
personal factors
• Places value on the clinical decision making required to provide
medically necessary care
2017 Evaluation Codes for PT Introductory Language:
• “…a patient history and an examination with development of a plan of
care…which is based on the composite of the patient’s presentation.”
• “Coordination, consultation and collaboration of care with
physicians…consistent with the nature of the problem(s) and the needs
of the patient, family, and/or other caregivers.”
Introductory Language: AT A MINIMUM…
Each of the following 4 components noted in the code descriptors must be
documented…:
• History
• Examination
• Clinical decision making
• Development of a plan of care
Definitions
• Body Regions: Head, neck, back, lower extremities, upper extremities, and trunk
• Body Systems:
– Musculoskeletal: gross symmetry, gross ROM, gross strength, height and weight
– Neuromuscular: gross coordinated movement (eg. Balance, gait locomotion, transfers, and
transitions) and motor function (motor control and motor learning)
– Cardiovascular pulmonary: heart rate, respiratory rate, blood pressure, and edema
– Integumentary: pliability (texture), presence of scar formation, skin color and skin integrity
A Review of ANY of the Body Systems ALSO includes:
•
•
•
•
•
The assessment of the ability to make needs known
Consciousness
Orientation (person, place, and time)
Expected emotional/behavioral responses
Learning preferences (eg learning barriers, education needs)
Definitions
• Body Structures: Structural or anatomical parts of
body, such as organs, limbs and their components,
classified according to body systems
Definitions
Personal Factors - Factors that include:
• Include sex, age, coping styles, social background, education,
profession, past/current experience
• Overall behavior patterns
• Other factors that influence how disability is experienced by
the individual
• PERSONAL FACTORS THAT EXIST BUT DO NOT IMPACT THE
PHYSICAL THERAPY PLAN OF CARE ARE NOT TO BE
CONSIDERED WHEN SELECTING A LEVEL OF SERVICE.
International Classification Functioning, Disability, and
Health (ICF)
• Developed by the World Health Organization (WHO)
• Standard language and framework for the description of all aspects of
health and some health-related components of well-being
• It is not an etiological framework (such as ICD-10 does)
• Comes from the perspective of the body, the individual, and society
ICF Information Organization
• Functioning and Disability
– Body systems and body functions
– Activities and participation (both individual and societal)
• Contextual Factors
– Environmental factors
– Personal factors
NEW Codes: 4 Components of Complexity and Severity
• Patient history (medical and functional, including relevant comorbidities
and personal factors) AND
• Examination AND the use of standardized tests and measures AND
• Clinical presentation of the patient AND
• Clinical decision making (including the use of a standardized patient
assessment instrument and/or measurable assessment of functional
outcome)
Patient History
•
•
•
•
Assists in supporting level of evaluation reported:
Comorbidities that impact function and ability to progress through a plan of
care
Previous functional level; context of current functional abilities
Treatment approaches in past if applicable and other factors that may impact
patients ability to progress and reach goals
Includes social history, living environment, work status, cultural preferences,
medications, other clinical tests, and more
Examination
Includes any of the following:
• Body structure and functions,
• Activity limitations (difficulty executing tasks or actions)
and/or
• Participation (in life situations) restrictions
ICF Domains of Activity and Participation
Mobility
• Self-care
• Domestic life
• Interpersonal interactions and relationships
• Major life areas
• Community, social and civic life
(includes but are not limited to)
Clinical Presentation of the Patient
• Stable and uncomplicated OR
• Evolving clinical presentation with changing clinical characteristics OR
• Evolving clinical presentation with unstable and unpredictable
characteristics
Clinical Judgement and Decision Making
• Based on the composite of the patient’s presentation (“the dynamic
interaction between the health condition and the contextual factors”- ICF)
• This clinical judgement occurs at each encounter or session informed as
much as possible by current best evidence.
“Typical Time”
is Used as GUIDANCE Only
97161 PT Evaluation- Low Complexity
97162 PT Evaluation- Moderate Complexity
97163 PT Evaluation- High Complexity
97164 Physical Therapy Re-evaluation
• A single level code
• Applies when there is an established and ongoing Plan of Care
• Requires an examination including a review of history AND the use
of standardized tests and measures
• Describes a REVISED plan of care using a standardized patient
assessment instrument and/or measurable assessment of functional
outcome
Building Blocks for New and Emerging
Payment Models
• Levels of evaluation reflect the complexity of the patient that
determines the management path
• Assessment tools at the front end and outcomes reported at the back
end begin to stratify how patients are successfully managed
• New codes will serve to differentiate the unnecessary variation in care
from medically necessary services for the individual patient, and
• Serve as the building blocks for future payment methodologies
Patient Scenarios
Patient Case # 1:
41 y/o female with a 3 yr. history of intermittent LBP, increasing in
frequency to daily over the past 2 mo. BMI 33, no other co-morbidities;
Fluctuating pain from 3-9/10; now 7/10. Ostwestry 35; Work as a day care
provider is interrupted at least 1x/wk. due to LBP; Unable to stand more
than 5 min; Sleep varies but is impacted 3/5 nights.
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case # 1:
41 y/o female with a 3 yr. history of intermittent LBP, increasing in
frequency to daily over the past 2 mo. BMI 33, no other co-morbidities;
Fluctuating pain from 3-9/10; now 7/10. Ostwestry 35; Work as a day care
provider is interrupted at least 1x/wk. due to LBP; Unable to stand more
than 5 min; Sleep varies but is impacted 3/5 nights.
BMI
Frequency/Chronicity
Work
Standing
Sleep
Evolving/Changing
Pain
Moderate
Ostwestry 35
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case # 2:
14 y/o male 4 days post knee sprain playing basketball; no prior injuries;
no co-morbidities; Pain is 4/10 (decreased from 8/10 at onset); LEFS score
45; moderate swelling of the knee; limited ROM; moderately impaired
balance; no deficits with the trunk, hip or ankle.
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case # 2:
14 y/o male 4 days post knee sprain playing basketball; no prior injuries;
no co-morbidities; Pain is 4/10 (decreased from 8/10 at onset); LEFS score
45; moderate swelling of the knee; limited ROM; moderately impaired
balance; no deficits with the trunk, hip or ankle.
No relevant comorbidities or
personal factors
1. LE (Knee, hip and
ankle)
2. Trunk
Stable and
predictable
Low
Complexity
 LEFS 45
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case # 3:
65 y/o male with 6 month history of pain and stiffness of his right shoulder.
Using NSAIDS and is self-limiting activity. History of poorly controlled
diabetes; reports dropping objects often, difficulty dressing and other self
care activities, and inability to assist in household activities all due to the
pain. Shoulder ROM limited in a capsular pattern. Low UEFS score.
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case # 3:
65 y/o male with 6 month history of pain and stiffness of his right shoulder.
Using NSAIDS and is self-limiting activity. History of poorly controlled
diabetes; reports dropping objects often, difficulty dressing and other self
care activities, and inability to assist in household activities all due to the
pain. Shoulder ROM limited in a capsular pattern. Low UEFS score.
Acuity/chronicity
Diabetes status
Carrying/handling
Self care
Household tasks
Upper Extremity
Unstable and
unpredictable blood
sugars
Moderate
complexity
UEFS
Evaluation Code Selection: 97161 □ 97162 □ 97163 □
Patient Case #4:
32 y/o female reports right posterior pelvic pain (5/10) after stepping off a curb 10 days ago.
The pain limits standing on the right lower extremity and transition from sit to stand.
Running is limited. Patient is 10 weeks post-partum and delivered vaginally with minimal
difficulty. History of intermittent low back pain over the years that typically resolves in 4-5
days. Denies significant past medical issue or need for medication. The PT examined lumbar
and hip ROM, joint accessory motion L1-S2 and Sacro-iliac joints, completed SIJ provocation
tests and MMT of the hip and trunk.
Patient Case #4:
32 y/o female reports right posterior pelvic pain (5/10) after stepping off a curb 10
days ago. The pain limits standing on the right lower extremity and transition from sit
to stand. Running is limited. Patient is 10 weeks post-partum and delivered vaginally
with minimal difficulty. History of intermittent low back pain over the years that
typically resolves in 4-5 days. Denies significant past medical issue or need for
medication. The PT examined lumbar and hip ROM, joint accessory motion L1-S2 and
Sacro-iliac joints, completed SIJ provocation tests and MMT of the hip and trunk.
Patient Case #5:
5 y/o girl presents one month s/p percutaneous left heel cord release to facilitate ambulation with heel strike at
initial contact. Past medical history is significant for left hemiplegia cerebral palsy. Level 1 - Gross Motor
Function Classification System (GMFCS). Prior to surgery, had zero degrees of passive dorsiflexion. Mother
reported increasing difficulty with ambulation. Examination:
- full passive left dorsiflexion; pain with passive stretch to gastroc-soleus muscle.
- stands independently but does not bear weight on left foot & maintains ankle in plantarflexion. Mother
reports she presently crawls rather than walks at home
- L ankle AROM: dorsiflexion: 6, plantarflexion: 40.
Goal of therapy: Independent ambulation without assistive device.
Patient Case #5:
5 y/o girl presents one month s/p percutaneous left heel cord release to facilitate ambulation
with heel strike at initial contact. Past medical history is significant for left hemiplegia cerebral
palsy. Level 1 - Gross Motor Function Classification System (GMFCS). Prior to surgery, had zero
degrees of passive dorsiflexion. Mother reported she was having increasing difficulty w/
ambulation. Examination:
- full passive left dorsiflexion; pain with passive stretch to gastroc-soleus muscle.
- stands independently but does not bear weight on left foot & maintains ankle in
plantarflexion. Mother reports she presently crawls rather than walks at home
- L ankle AROM: dorsiflexion: 6, plantarflexion: 40
History
Examination
Presentation
Goal
of therapy
ambulation
L hemiplegic
CP is independent
PROM
L ankle without assistivedevice.
Stable, uncomplicated,
GMFCS I
Pain
decreased weight bearing L
abnormal/reduced mobility
improving
Decision-Making
 Low complexity
Patient Case #6:
18 y/o female with cystic fibrosis referred to PT for review/ refresh of airway clearance
program. She is moving away from home to attend college and needs to be
independent in disease management. Patient lives w/ both parents and an older nonCF sibling. Her mother is concerned about her ability to maintain her regimen,
including hygiene of respiratory equipment. She has mild airflow obstruction that has
been stable for the past few years. No recent hospitalizations. She is not a regular
exerciser, but knows better endurance is needed to navigate campus. She has
pancreatic insufficiency and takes replacement enzymes. BMI is 19.
Patient Case #6:
18 y/o female with cystic fibrosis is referred to PT for review/refresh of airway
clearance program. She is moving away from home to attend college and needs to be
independent in disease management. Patient lives w/ both parents and an older nonCF sibling. Her mother is concerned about her ability to maintain her regimen,
including hygiene of respiratory equipment. She has mild airflow obstruction that is
stable for the past few years. No recent hospitalizations. She is not a regular exerciser,
but knows better endurance is needed to navigate campus. She has pancreatic
insufficiency and takes replacement enzymes. BMI is 19.
History
 Imminent decline in
psychosocial support
Examination
 Airway Clearance
 Endurance
Presentation
 Stable pulmonary disease
& nutritional status
Decision-Making
 Low complexity using
standardized patient
assessment instrument
and/or measurable
assessment of functional
outcome
Patient case #7:
28 y/o male with cystic fibrosis was recently discharged from the hospital following an acute
exacerbation with RUL pneumonia. His FEV1% predicted declined to 65% from his typical baseline of
72%. Two exacerbations requiring hospitalization over the past 2 years. Over last year patient lost 12#
w/ BMI 18.
Past medical history: multiple hospitalizations for pulmonary infections, pancreatic insufficiency, CFrelated DM
• Current Meds: bronchodilators, insulin, pancrease, and mucolytics
• Social history: married living with spouse. Works FT as a university research librarian
• Patient goal: Reduce exacerbations and return to life roles in work and family
• Examination findings include:
– Course breath sounds throughout; cough strong/ productive of thick, tenacious sputum
– Mild kyphosis with forward head; decreased rib joint mobility throughout thoracic level
– SpO2 93% on room air, declines to 90% during 6MWT
Patient case #7:
28 y/o male with cystic fibrosis was recently discharged from the hospital following an acute
exacerbation with RUL pneumonia. His FEV1% predicted declined to 65% from his typical
baseline of 72%. Two exacerbations requiring hospitalization over the past 2 years. Over last
year patient lost 12# w/ BMI 18. Examination:
– Course breath sounds throughout; cough strong and productive of thick, tenacious
sputum
– Mild kyphosis with forward head; decreased rib joint mobility throughout thoracic level
– SpO2 93% on room air, declines to 90% during 6MWT
History
Current inability to
return to FT work
Diabetes
Examination





Airway Clearance
Exercise tolerance
Posture
Thoracic mobility
Vital signs
Presentation
Acute decline in pulmonary
function
Acute decline on nutritional status
Decision-Making
moderate complexity using
standardized patient assessment
instrument and/or measurable
assessment of functional
outcome
Patient case #8:
30-month-old female w/ arthrogryposis is 4 wks s/p foot surgery to excise the talus bone
bilaterally. Her parents accompany her to the clinic. Bilateral casts were removed a week
ago and she is now weight bearing as tolerated. Parents’ goal is for her to walk
independently using the posterior rolling walker. Before surgery, she could walk w/ a
posterior rolling walker with assistance. She attends daycare and has two older sisters.
Examination:
- Finger flexion contractures bilaterally; both UEs are biased toward extension with
hypermobility into excessive extension (0 to 30 deg), limited elbow flexion (0 to 45 deg)
- LEs fixed into extension w/hypermobility (0 to 20 deg). Ankles are positioned in a neutral
Dorsiflexion/Plantarflexion position. Incision sites are closed, clean and dry.
- Bilateral solid AFOs. Stands w/ minimal assistance with shoes and braces.
- Walks w/posterior rolling walker for 10 feet before complaints of fatigue & lowering
herself to the floor
Patient case #8:
30-month-old female w/ arthrogryposis is 4 wks s/p foot surgery to excise the talus bone bilaterally. Her parents
accompany her to the clinic. Bilateral casts were removed a week ago and she is now weight bearing as tolerated.
Parents’ goal is for her to walk independently using a posterior rolling walker. Before surgery, she could walk w/ a
posterior rolling walker with assistance. She attends daycare and has two older sisters. Examination:
- Finger flexion contractures bilaterally; both UEs are biased toward extension with hypermobility (0 to 30 deg);
limited elbow flexion (0 to 45 deg)
- LEs fixed into extension w/ hypermobility (0 to 20 deg). Ankles are positioned in neutral Dorsiflexion/
Plantarflexion position. Incision sites are closed, clean and dry.
- Bilateral solid AFOs. Stands w/ minimal assistance with shoes and braces.
- Walks w/posterior rolling walker for 10 feet before complaints of fatigue & lowering herself to the floor
History trial for modification,or
Examination
Decision-Making
• ic reassessment,
change in assistive device Presentation
 30 month old with
arthrogryposis
 4 weeks post reconstructive
surgery bilateral feet
 Multi-joint involvement




Pain
decreased weight bearing
Abnormal/reduced mobility
fatigue
 Unstable characteristics
- at risk for decline in mobility
 High complexity
Where can you learn more about these new codes?
Coming before the end of the year:
• Online self-paced course w/ examples of scenarios from various
patient populations will be available in the Learning Center at
www.apta.org
• APTA pocket guide (12/2016 PTinMotion)
• FAQ from 9/2016 webinar
• http://www.apta.org/PaymentReform/NewEvalReevalCPTCodes/
Where can you learn more about these new codes?
• Published articles in PTinMotion magazine
• The following references….
References
http://www.apta.org/Payment/Medicare/CodingBilling/FeeSchedule/Summaries/2016/7
/15/
http://policy.apta.org/NationalIssues/APS/
http://www.apta.org/PTinMotion/News/2016/9/7/FeeSchedule/
http://www.apta.org/uploadedFiles/APTAorg/Payment/Medicare/Coding_and_Billing/Fe
e_Schedule/Comments/APTAComments_FeeSchedule2017ProposedRule.pdf
References
• APTA Guide to Physical Therapist Practice 3.0; http://guidetoptpractice.apta.org
• APTA Guideline: Physical Therapy Documentation of Patient/Client Management; BOD G03-05-1641
• 2017 CPT® Manual, Professional Edition
• APTA FAQ: Evaluation & Reevaluation
http://www.apta.org/Payment/Coding/FAQs/EvaluationReevaluation/
• International Classification of Functioning, Disability and Health (ICF), WHO 2001
https://www.amazon.com/International-Classification-Functioning-Disability-Health/dp/9241545445
Final 2017 Physician Fee Schedule
• CMS held to the tiered evaluation codes – and the same reimbursement
for each.
• CMS reconsidered and will increase payment for reevaluation from 0.60 to
0.75.
• Claim reviewers won't be able to use the new codes to "ding" manual
medical reviews.
• The misvalued codes—all 10 of them—will be in play in 2018.
• APTA regulatory affairs staff is reviewing the final rule and will develop a
more detailed summary in the coming weeks.
• http://www.apta.org/PTinMotion/News/2016/11/2/FinalFeeSchedule2017/
APTA Opioid Campaign
Q3 Highlights
•
June launch at NEXT
•
Times Square billboard
•
Online advertising
•
Strong chapter support
•
Online/social release of video PSA
Q4 Highlights
•
NY student appearances on TODAY and GMA morning shows
•
PSAs (TV and radio) airing nationwide
•
Online/social advertising continues
•
Multiple component campaigns
Pain
• Question: How much did we spend on treating pain in
2010?
– Answer: $500 –$635 billion dollars
• Compared to…
– $150 billion dollars in 1995
• Spending on pain increased 4x in 15 years
Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8).
Is this money well spent?
• One management strategy that
rapidly drove up costs was rate of
prescription opioids
– Sales of prescription opioids have
literally quadrupled since 1999
• So have opioid related deaths (165,000
since 1999)
– 1/5 patients who present to a
physicians office w/ complaint of
pain, will be prescribed an opioid
Feeding Our Nation Opioids
• In 2012, 259 million prescriptions for opioid pain
medication written.
• To put this into perspective:
– There 300 million people
living in the United States
Where’s the Evidence? The CDC says…
• Insufficient evidence to support long-term opioid use and little
evidence that they improve functional outcomes
• If opioids are used, they should be combined with nonpharmacological therapy, such as physical therapy
• “Clinicians should consider opioid therapy only if expected
benefits for both pain and function are anticipated to outweigh
the risks to the patient.”
Where’s the Evidence?
• “High-quality evidence” (CDC) that exercise as part of a
physical therapy treatment plan for low back pain, hip
and knee osteoarthritis, and fibromyalgia is effective for
reducing pain and improving function.
• We need to move toward better pain management…
Know Pain, Know Gain
1. “Knowing Pain” (neurophysiological explanation from a PT)
reduces overall cost of care
2. Overutilization of Imaging increases costs (and fear)
3. Early activity and movement decreases long-term costs
Knowing Pain
• A recent study published in the journal Spine (2014),
followed a group of individuals who were undergoing
surgery of the lumbar spine.
– The researchers followed up with the participants 1 year after
surgery and found the group who received a single,
educational session from a physical therapist, viewed their
surgical experience much more favorably, and utilized 45%
less health care expenditure following surgery.
Louw A, Diener I, Landers MR, et al. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up.
Spine 2014: 39; 1449-1457.
Image Overutilization
• Researchers have found that individuals who get advanced
imaging for LBP will cost $4700 more as compared to those
who get PT first
– “Labeling” (Fritz et al 2015)
Early Activity and Movement
• Early PT for pain decreases risk for advanced imaging,
additional physician visits, surgery, injections and opioids (Fritz
2012)
– Total medical costs are $2736 lower
Early Activity and Movement
• Physical therapy is a safe and effective
solution for long-term pain management
• Early physical therapy is cost-effective
relative to usual primary care after 1 year
for patients with non-specific LBP (Fritz
2016)
Registry
Practice
Research
Data
Collection
Payment
Quality
©2016 American Physical Therapy Association. All rights
reserved. All reproduction or redistribution prohibited.
Physical Therapy Outcomes Registry
•
•
•
•
•
Track performance of
care delivery and
documentation
patterns
Assess adherence
to CPGs
Practice
Quality
Research
Payment
Drive health
services research
initiatives
Demonstrate value of
physical therapist services
Fulfill quality reporting
requirements
• Support quality
improvement initiatives
•
• Inform payment
contract negotiations
Guide payment policy
Data From the Profession For the Profession
When you use a PT Outcomes Registry,
you help to ensure that physical therapists,
rather than other parties, identify what
practices work best and for whom.
How PT Outcomes Registry Works
Outputs
Inputs
• Demographic information,
• Diagnosis/ condition (via ICD-10)
• Comorbidities (via ICD-10)
• Relevant surgical history
(planned)
• Pain intensity
• Functional level (global,
condition/ body region specific,
performance based)
• CPT codes
• Reports allows clinicians to look at
individual episode and aggregated
episodes by diagnosis/ condition
• Change in function over the
episode and functional level
achieved
• Change in pain over the episode
• Number of visits per episode
• Quality performance
©2016 American Physical Therapy Association. All rights
reserved. All reproduction or redistribution prohibited.
Practices can use PT Outcomes Registry data to:
Enhance Clinical Decision Making for Better Patient
Care
Monitor Documentation Practices & Decrease
Unwarranted Variation
Improve Practice Efficiency & Resource Allocation
Demonstrate Commitment to Quality Outcomes to
Payers
Benchmark Performance at Practioner, Facility, &
National Level
Market Strengths to Consumers by Showing Outcomes
Registry Timeline
2015
2016 Fall
Pilot phase
Soft Launch
2016 Summer
Close Pilot
©2016 American Physical Therapy Association. All rights
reserved. All reproduction or redistribution prohibited.
2017 Public
Launch
PT Outcomes Registry
can help you visually show the status of your practice.
For more information :
[email protected]
www.ptoutcomes.com
Manual Therapy
Manual Therapy CPT Code 97140
Skilled interventions to joints/ soft tissue
Improve tissue extensibility; increase range of motion; mobilize or
manipulate soft tissue and joints; modulate pain; reduce soft tissue
swelling, inflammation, or restriction
May include manual lymphatic drainage, manual traction, massage,
mobilization/manipulation, and passive range of motion.
Manual Therapy CPT Code 97140
Literature reviews highlight efficacy of manual therapy AND cost
benefits on the total episode of care
One study focused on cost-effectiveness of MT techniques vs
corticosteroid injection for chronic lateral epicondylalgia
Study result: patients receiving PT had higher initial costs but
overall cost of care was lower than w/ corticosteroid injections
Manual Therapy CPT Code 97140
Since 2015 increased code scrutiny by a few commercial payers
Mid west payer proposed 35% reduction for this procedure
State of Virginia employees (covered by one commercial payer)
have separate MT co pay if used during treatment session
Manual Therapy CPT Code 97140
APTA efforts:
Met w/ affected states in the mid west & payer to discuss
effectiveness of manual therapy
Sent letter including research evidence illustrating MT benefit
Results:
Payer agreed to modify proposed reduction
Manual Therapy CPT Code 97140
State of Virginia
Efforts to resolve:
Chapter leading effort to interface w/ payer & developer of state
employees benefit
Manual Therapy CPT Code 97140
Major commercial payer Louisiana:
Separate co pay when MT is used during a treatment session
and
Will deny payment if MT is billed & practitioner IS NOT a chiro
Florida auto liability carrier is denying payment when
CPT 97140 is submitted on claims
Manual Therapy CPT Code 97140
State of
Florida and Louisiana
Efforts to resolve:
APTA monitoring chapter efforts/ providing resources as needed