Question: I've been asked to start ...

Question: I've been asked to start an inpatient cardiac rehabilitation program as part of the physical therapy program. for what reason do I set up my billing? What are the constitutings of the program? Where can I inflect for resources?

Answer: Many physical therapists are involved in the inpatient initial phase of cardiac rehabilitation, particularly working with patient's postmyocardial infarction (MI) or coronary artery bypass graft (CABG) surgery and individuals with heart failure. These individuals repeatedly require assistance with ambulation, ADLs, and/or transfers, especially if they are older have co-morbidities, or experienced complications during their hospitalization.

The billing onward an inpatient basis is based onward diagnostic related groups (DRGs) for hospitals and for the admitting diagnosis. The traditional CPT digests used for inpatient billing are the 97000 series and should be used based with the activity you are performing and the amount of time you pass with each individual patient. (Keep in mind these are primarily used for internal auditing.) The typical activities include: initial evaluation, monitored exercise (or therapeutic procedures) ADL training, transfer training, and gait.

The difference in billing in cardiac rehabilitation is with discharge to the outpatient program. one time a patient enters outpatient cardiac rehabilitation, the billing is completely different. There are merely 2 billing codes that are appropriate for the outpatient cardiac rehabilitation program and are used from all appropriate disciplines:

93797-physician services for outpatient program without continuous ECG monitoring (this is used for your phase III cardiac rehabilitation-a digest that is subject to regional interpretation and not accepted according to all intermediaries) and

93798-physician services for outpatient program with continuous ECG monitoring (this is used for your phase II cardiac rehabilitation)

Medicare will reimburse for 93798 if the patient has single of the following diagnosis digests (per the ICD-9 Code Book):

Stable angina 4139

CABG surgery 414 and then V4581

Anterolateral AMI 41002

Anterior AMI 41012

Inferior lateral AMI 41022

Inferior AMI 41042

Lateral AMI 41052

Unspecified AMI 41092

However, all other guidelines for a cardiac rehabilitation program must be followed, including appropriate physician supervision during the hours of the program, as well as appropriate documentation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) is a great resource for guidelines for cardiac rehabilitation, competencies of personnel and administrative recommendations. The Guide to Physical Therapist Practice also provides practice patterns for management of patients with cardiac muscle dysfunction.

The ingredients of a cardiac rehabilitation program include education (of the coronary artery disease, treatment, etc) diet instruction, and evaluation and management of psychosocial issues in the same state [i]or[/i] condition as stress, anxiety, and depression. The and nothing else component of cardiac rehabilitation that is billable at physical therapy is the monitored exercise/activity and functional training. Education is not a billable ingredient but must be included in the rehabilitation.

UPDATE

Local Medicare Review Policies (LMRPs) are now called Local Coverage Determinations (LCDs) are revised and rewritten constantly for all areas of practice and in all areas of the political division It is extremely important that each physical therapist monitor their confess carrier or intermediary's state or region's LMRP/LCD for physical therapy as well as for other disciplines, and if applicable for pulmonary or cardiac rehabilitation. Contact the Legislative Committee if you know of any changes that might affect physical therapy practice.

A great example of a fresh event with LMRPs occurred in North Carolina in February. The Respiratory Therapy LMRP was lately revised, a draft published, and a "comment time period" provided. Wording was revised in the draft LMRP that significantly impacted physical therapy and a certain quantity of local PTs became aware of these changes. Although the Physical Therapy LMRP allowed for billing of physical therapy services for pulmonary rehabilitation, the Respiratory Therapy LMRP appeared to limit the physical therapy practice and billing in the pulmonary rehabilitation area. from being alerted to this modern wording, the APTA Government Affairs office was able to provide remarks in response to the draft LMRP language limiting physical therapy billing. The final wording and decision has not been columned as of the date of the writing of this update (April 2004)

Please hold fast us informed!!!!!

Please address all questions, bear upons comments to the Legislative Committee Chair, Ellen Hillegass (ezhillegass@mindspring.com).

Copyright Cardiopulmonary Physical Therapy Journal Jun 2004

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