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Subscribe to this list via RSS Blog posts tagged in Payers & Reimbursement

Wonder girl

Dear Andrea,

I took your Musculo Primer class in Eden Prairie last Summer with the people from Hong Kong. I am wondering if you can send/forward me a sample of one of your daily PT notes for pool therapy. We are getting more pool referrals from MDs and I am putting what I learned from your class to use :) but wanted to see an example or template for daily notes, especially to ensure I'm documenting all the correct things for reimbursement. I am hoping to take another of your courses in the upcoming year!  Thanks, Sarah L, Northfield, MN

Dear Sarah,

Thank you so much for the kind words. We are delighted to hear that your business is prospering. To that end, I have attached some samples to use for documentation. I am also enclosing library language that you are free to use in your assessments to justify aquatic therapy.

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b2ap3_thumbnail_6a00d83453c2c669e2017ee9963bc4970d-320wi.jpgYou've heard every rationale in the book from payers who want to discontinueaquatic therapy.

  • "It's not functional; people don't live in the water"
  • "6-8 visits to teach the exercises, then an immediate transition to land"
  • "You don't need a skilled therapist to teach water aerobics." (my personal favorite)

So, when the day comes when a gorgeous piece of literature comes out which makes the case for aquatic therapy -- and that case is not just (unequivocally) pro-aquatic therapy, but pro-starting-as-early-as-4-days-post-op, well, it's time to celebrate.

This systematic review/meta-analysis is equivalent to the Holy Grail... desired by all, long sought, yet always elusive.

Attend March 26th webinar for a much more extensive look at the ramifications of this study and many others. We will be incorporating this study into a free brochure you can use to give to refering physicians after the webinar.

REVIEW ARTICLE (META-ANALYSIS): Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis.

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Have you noticed the new push for justification?

Aquatic therapy is on the cusp of an explosion of popularity, but watch out! Because insurers pay more for aquatic therapy than almost any of therapeutic procedure, they are starting to demand clear and ongoing justification for continued aquatic treatment.

Well, you are in luck.

Thanks to the heavy lifting being done at Aquatic Therapy University, we have some library language that can be inserted directly into your computerized documentation system.

You have ATU's permission to incorporate this language for clinical uses!

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b2ap3_thumbnail_6a00d83453c2c669e201774400c0bf970d-320wi.jpgQuestion: We recently received a request from our Medicare Contractor asking for documentation that verified that the therapist was in the water during aquatic therapy session. We have never had this request before.

Most of our sessions, the therapist is in the water, but sometimes she is not. Under neither circumstance do we specifically document the location of the therapist. Is this a valid restriction or reason for denial? Does the therapist have to be in the water for it to be considered skilled care. Help!

Answer: OK, let's tease out the two issues being discussed here. 

Skilled versus Unskilled Care.

First, is the care "skilled"? The answer is: it depends. Certainly, a therapist who remains on the deck for part of a session is not automatically providing "unskilled" care. In fact, here are some examples of situations that I would argue the therapist should position him or herself on the deck specifically in order to increase the caliber of care provided:

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b2ap3_thumbnail_6a00d83453c2c669e2016769270bcd970b-320wi.jpgLooking for tips to ensure your documentation supports the need for aquatic therapy?

Consider the following points outlined by National Government Services when providing aquatic therapy services.

(Editor's note: I don't agree with all of these points but I am listing them so you see what you are being asked to do)

  • Does your patient require the skills as a therapist, or could the patient achieve functional improvement through a community-based aquatic exercise program?
  • There are a limited number of therapeutic exercises generally performed in the water. These exercises become repetitive quickly. Once a patient can demonstrate an exercise safely, you may no longer bill Medicare for the time it takes the patient to perform this now independent exercise. If the same exercise is performed over a number of sessions, the documentation must describe the skilled nature of the qualified professional’s/auxiliary personnel’s intervention during the therapeutic exercise to support the ongoing medical necessity.
  • Patients who will not be continuing their water-based program as a maintenance program should be transitioned to land-based exercises as soon as reasonably possible for the patient’s condition.
  • The aquatic therapy treatment minutes counted toward the total timed code treatment minutes should only include actual skilled exercise time that required direct one-on-one patient contact by the qualified professional/auxiliary personnel. Do not include minutes for the patient to dress/undress, get into and out of the pool, etc.
  • Do not bill for the water modality used to provide the aquatic environment, such as whirlpool (97022), in addition to 97113.
  • See CPT 97150 Group Therapy for guidelines when treating more than one patient at the same time in the aquatic environment.

Supportive Documentation Recommendations for 97113

  • Justification for use of a water environment
  • Objective loss of ADLs, mobility, ROM, strength, balance, coordination, posture and effect on function
  • If used for pain include pain rating, location of pain, effect of pain on function


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b2ap3_thumbnail_6a00d83453c2c669e20176171c20b9970c-320wi.jpgLooking to support aquatic therapy? Frustrated at abstracts that don't give the whole picture? Click on the links here and get open access to these evidence-based guides and clinical studies.

Evidence-Based Links

Recent Clinical Trials (free dowloads)

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Question: The president of our Senior Living complex spoke with me last night about conducting a survey or a study within our properties that will show the importance of a fitness/wellness program and facility in senior housing. 

They would like to look at decreased falls, decreased days in the hospital/TCU, decreased medical cost, etc.  Are you aware of anything out there like this or a contact?  I do not have a lot of experience in research, so any pointers would be appreciated.

Answer: Here are some tools that will help you assess function and determine improvement. They are not aquatic-specific.


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