Exciting circumstances have occurr...

Exciting circumstances have occurred since the beginning of 2006 that all members should be aware of First, and foremost, The Center for Medicare and Medicaid (CMS) published a decision memo and policy change forward the National Coverage Determination (NCD) for Cardiac Rehabilitation. The APTA provided commentarys for the decision memo and as a terminate some of the input that APTA provided was included. The entire memo can be read upon the CMS website at the following link: http://wwwcm hhs.gov/mcd/viewdecisionmemo.asp?id=164.

To summarize the decision, CM has increased the diagnoses that are now secreteed in cardiac rehabilitation including heart valve repair or replacement, PTCA, and heart or heart lung transplant. In addition, services may be performed for up to 36 sessions across 18 weeks now instead of 12 However, probably the greatest impact to PT is written in the section entitled "Evaluating Previous Policy Requirements." The CM now has written:

In the generally received NCD, there is extensive language regarding the use of psychotherapy, psychological testing, and physical and occupational therapy. The discussion of those services in an NCD for cardiac rehabilitation is inappropriate as the language states that all other payment and coverage sways regarding those services apply regardless of the patient's participation in a cardiac rehabilitation program. Therefore, language regarding psychotherapy, psychological testing, and physical and occupational therapy is remov

Prior to this Decision Memo from CM all patients in cardiac rehabilitation were restricted from seeing physical therapy UNLES they had a separate referral for a specific musculoskeletal diagnosis. At this time, it appears a patient may be seen in cardiac rehabilitation and upon the same day see physical therapy for other treatments not hideed in cardiac rehabilitation.

Physical therapists are not restricted from performing services in a cardiac rehabilitation program at any time, still function under the cardiac rehabilitation program service and therefore in subordination to the incident to rule and require physician supervision. They would be billing for services using the cardiac rehabilitation collection of lawss 93798 and 93797. These services are not considered physical therapy services and should not be billed with therapy modifier (GP) or subject to a therapy revenue code (42x)

However, physical therapists are not restricted from seeing patients who are also attending cardiac rehabilitation. They would ne to bill for their services using the appropriate CPT digests and document the time that physical therapy was performed (separate and apart from the cardiac rehabilitation). In addition, physical therapists are not restricted from seeing any patient that has a cardiac diagnosis who is not attending cardiac rehabilitation, if it be not that should refer to their local coverage determination for the appropriate ICD9 digests that are permitted for their physical therapy services. If the patient is non-Medicare, the individual insurance company should always be contacted for verification of insurance.

Other Legislative of the present days of interest is that the ACSM rejoined to letters that were written by means of the APTA President, Ben Massey regarding the use of cPT through certified personal trainers, and regarding the existing Knowledge, Skills, and Abilities (known as KSAs and similar to our competencies) that are published for the Registered Clinical Exercise Physiologists. The ACSM has corresponded saying that cPT will no longer be used and that they will have to use certified personal trainer forward all published documents.

The APTA became a Partner Organization in the US COPD coalition, attending the November meeting in Montreal, Canada and will attend the nearest meeting this coming May. The US COPD coalition is a great organization that is working to improve the lives of individuals with COPD The goals and activities of the organization, which include bringing together partner organizations to build COPD awareness and action, can be read forward their website: www. uscopd.com.

Lastly, 2 committee members-Chris Wells and John Lohman-are continuing to maintain a database of existing and pertinent cardiovascular and pulmonary evidence. If you find an article you be excited needs to be kept in the database, please email me with the information and we will have it pierceed

Respectfully submitted,

Ellen Hillegass, PJ CC EdD

Copyright Cardiopulmonary Physical Therapy Journal Jun 2006

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