CPT Coding Proposal That Better Describes Occupational Therapy Developed by AOTA Team
By Stephanie Yamkovenko
The American Occupational Therapy Association (AOTA) is continuing to work on revisions to the Current Procedural Terminology (CPT) Physical Medicine and Rehabilitation (PM&R) codes, to address concerns by the Centers for Medicare and Medicaid Services (CMS), and also to ensure that occupational therapy services can be effectively reported.
“Our coding group worked very hard to develop a proposal that was descriptive of what occupational therapy did, but also was in a language that would be understandable to payers, policymakers, and consumers,” says Christina Metzler, chief public affairs officer at AOTA.
AOTA’s Board of Directors convened the AOTA coding workgroup in September 2011 to develop a proposal focusing on the PM&R section of codes, which are the main codes that occupational therapy practitioners bill. It was clear to the Board and AOTA staff that there was a need for the profession to consider these critical issues of payment as many policymakers, the AMA, and CMS were questioning the current PM&R code values based on increased utilization and charges over the past several years. (Read more about the workgroup here.)
AOTA’s workgroup decided that the environment provided an opportunity to recommend language that better reflects occupational therapy practice by incorporating International Classification of Functioning, Disability, and Health (ICF) terminology. ICF language also can be used in many cases to demonstrate progress, as the patient moves from direct treatment of a condition to the ultimate goal of participation in activities of daily living and instrumental activities of daily living.
CMS contractors have suggested use of ICF terminology in describing and reviewing therapy services in various contexts. The proposal creates new core codes that take into account contemporary practice and do a better job of describing a therapy session. “The coding workgroup developed this descriptive proposal because they believe it is important to create codes that truly speak to what occupational therapy interventions are about,” says Metzler. “And also that the proposal fits the framework of the CPT system too.”
The American Physical Therapy Association (APTA) also has developed a proposal—which has been several years in the making, but takes a different approach. AOTA has met with APTA several times regarding the similarities and differences between the proposals.
“We have been working with APTA to try to more fully understand each other’s proposals and to come to points of agreement where possible,” says Metzler. “We continue to have meetings and conversations to work together to try to address the concerns about the codes while also considering some of the other dynamics in the policy arena.”
Ultimately, the decision about any changes to codes rests with the American Medical Association and the CPT Editorial Panel. Occupational therapy practitioners should be aware that there will very likely be changes to CPT codes in the PM&R section in the next few years. However, these changes will not affect billing for occupational therapy services using codes in other CPT sections.
“CPT codes are the predominant way payers record services and are also linked to payment, particularly in Medicare outpatient therapy,” says Metzler. “Any changes to the CPT PM&R codes will affect almost all practitioners because it is the commonly used way to report and document evaluations and interventions. This is very high impact endeavor, which is why AOTA is so committed to creating codes that accurately reflect practice.”
Read a brief overview of AOTA's Proposed Physical Medicine and Rehabilitation Coding changes here.
Stephanie Yamkovenko is AOTA’s Web editor.