AOTA Convenes Experts to Discuss Coding and Reimbursement Policy Strategies

January 17, 2018

In an effort to ensure that the full scope of occupational therapy services are accurately represented in coding and documentation policies, the American Occupational Therapy Association (AOTA) recently held a 2-day Coding Advisory Meeting focused on the CPT® codes used by occupational therapy practitioners in billing. Volunteer AOTA member experts along with AOTA Regulatory Affairs staff members, gathered last month to discuss the current volatile payment environment and its impact on daily practice—as well as the future of the occupational therapy profession.

“Payment, documentation, diagnosis, and correct coding are all daily concerns for occupational therapy practitioners,” said Christina Metzler, Chief Public Affairs Officer for AOTA. “The input gathered from AOTA’s Coding Advisory Meeting will be used to identify possible AOTA activities aimed at alleviating important reimbursement and practice problems for practitioners.”

Nationwide, more than 213,000 occupational therapy practitioners work with clients across the lifespan to participate in the everyday activities (occupations) they want and need to do despite illness or injury. Occupational therapy practitioners work to increase independence and focus on clients’ individual goals.

AOTA staff, AOTA coding advisors to the American Medical Association (AMA) CPT® related committees, and invited member practitioners with expertise in billing and coding continue to work together to develop strategies to target advocacy, education, and other AOTA activities.

“The payment environment is in a state of great change. We have to promote the distinct value of occupational therapy through correct coding,” noted Mary Foto, OT, FAOTA, CCM, a meeting participant who has represented AOTA with the AMA for more than 20 years, currently as AOTA’s Alternate to the Relative-Value Scale Update Committee (RUC).  “This meeting provided the opportunity to discuss how to empower practitioners to use codes like the self-care code (97535) to really represent the work of OT in moving people to fuller function.”

The discussion was framed around third-party payers (including the Centers for Medicare and & Medicaid Services [CMS], commercial and managed care payers, and workers compensation), occupational therapy practitioners and other health care professionals, consumers, and the AMA, which owns and controls the CPT® system. The group reviewed the current landscape of occupational therapy billing and reimbursement, including presentations on code utilization, new alternative payment models and telehealth considerations, with discussion questions to help frame key challenges facing occupational therapy in coding and payment. Foto commented that the importance of this meeting was to identify next steps in outreach to payers and in appropriate practitioner use of codes.

Recent AOTA-funded studies examined the use of codes and sites of service. Data show that use of the self-care/activities of daily living code (97535) in Medicare is very limited compared with use of the therapeutic exercise code (97110). Ideas were put forward on how to ensure that the full scope of occupational therapy practice is not restrained by coding, billing, or payment practices.

Also discussed was the option of improving code descriptor language to better reflect contemporary practice, similar to recent updates achieved by AOTA to the orthotic code language (for more on this, see https://goo.gl/Wcvc2o).

Participants also reviewed the progress on use of new evaluation codes for occupational therapy in 2017 which was viewed as a significant victory; the code language now reflects the clinical reasoning process and the targets of occupational therapy: physical, cognitive, and psychosocial performance. Another victory noted was AOTA’s success in achieving increases for most codes in 2018 (see https://goo.gl/CyBRkL).

AOTA wants to take action to help practitioners with this daily challenge and work to assure that the full scope of practice is reimbursed. “Discussions made clear that a multi-tiered approach, including advocacy and education, was needed to help practitioners to improve appropriate reimbursement for occupational therapy practice,” said Metzler. “Such an approach should target not only practitioners and payers, but also consumers who receive occupational therapy services. Correct coding and clear documentation have a direct effect on not only reimbursement, but on promoting the value of occupational therapy.”

A report of the discussions will be developed and presented to the AOTA’s Board of Directors in late February. For more information on coding issues, visit AOTA’s website, www.aota.org.

 

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