• Situation

    Peter, PT, DPT, (age 24) is a new professional. Upon graduation from a physical therapist program, he was hired by a busy private practice providing aquatic therapy for patients with Medicare. He enjoys being in the pool with his patients to provide direct hands-on therapy. The practice, however, has become so busy that he no longer has time to provide direct hands-on therapy with each patient 1-on-1. His supervisor, the practice owner, suggests he schedule all patients requiring aquatic physical therapy sessions at the same time. "That way," he said, "you can direct the therapeutic exercises of several patients simultaneously from the pool deck, and bill CPT code 97113 for each patient." After doing this for several months, Peter discovers the CPT code (97113) he’s been using is defined only for 1-on-1 contact with a single patient, not multiple patients from a distance.

    Peter has a dilemma. He knows for sure he can no longer continue to bill group sessions as if they were 1-on-1. But what about the sessions he’s already billed? Should he go back and correct those, even though the practice has already been paid for them? And what about telling his supervisor, the practice owner? It is possible his supervisor was just mistaken about the coding. Shouldn’t he give him a chance to correct his mistake? What if his supervisor thanks him for pointing out the error and tells him to use the correct code going forward but not to worry about the already-billed sessions as that would be an administrative nightmare? What should Peter do then?

    Appropriate Response

    Peter should correct the previous coding errors with the proper notation and his signature. Peter should also inform his supervisor of his intentions. If the supervisor insists the previous errors stay uncorrected, Peter should find a new job and consider reporting the supervisor to the compliance officer or the federal government. He also should refer to the CMS Manual System for guidance on making amendments, corrections, and delayed entries in medical records.

  • Last Updated: 9/10/2014
    Contact: practice-dept@apta.org