Can You Pass the CMS’s Assistant Modifier Quiz?

On January 2, 2020 the CMS’s Assistant Modifier Designation begins. Are you ready? There are 10 scenarios listed below that will test your readiness.

A PT independently provides 10 minutes of therex and the practice employs at least one PTA. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP 1

The CQ modifier is not required

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A PT independently provides 10 minutes of therex (satisfying the 8-minute rule) and a PTA independently provides 10 minutes of therex (also satisfying the 8-minute rule). How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP CQ 1

The CQ modifier is required

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A PT independently provides 8 minutes of therex (satisfying the 8-minute rule) and a PTA independently provides 1 minute of therex. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP CQ 1

The CQ modifier is required

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A PT independently provides 11 minutes of therex (satisfying the 8-minute rule) and a PTA independently provides 1 minute of therex. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP 1

The CQ modifier is not required

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A PT provides 10 minutes of therex and a PTA assists the therapist for 5 minutes. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP 1

The CQ modifier is not required

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A PT independently provides 20 minutes of therex and a PTA independently provides 5 minutes of therex. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP 1

97110 GP CQ 1

97110 is billed on two separate lines on the HICFA

One line without the CQ modifier

And a second line with the CQ modifier

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A PTA independently provides 20 minutes of therex while a PT is 10 feet away, within line of sight, supervising the PTA for the full 20 minutes. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP CQ 1

The CQ modifier is required

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An OT independently provides 11 minutes of therex and a COTA then independently provides 2 minutes of therex with the same patient. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GO CO 1

The CO modifier is required

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An OT provides 10 minutes of therex and then the COTA joins the OT for 8 minutes during the process. How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GO 1

The CO modifier is not required

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A PTA in a CORF provides 20 minutes of therex (PTAs do not require PT supervision in a CORF). How is this billed?

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CPT Mod1 Mod2 Unit Charge

97110 GP CQ 1

The CQ modifier is required

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How did you do? Did you know how to properly code each of the 10 scenarios above?

If not, do you know why the stated answer is correct?

Are you ready to make these decisions, on the fly, while co-treating patients with other therapists in a hectic treatment environment?

Do you know what additional documentation is needed to properly defend each scenario, so that years from now, the auditor can determine who delivered how much of each exercise, treatment, and modality? (This defensive content is required on every Medicare note written.)

If your answers to those questions are “Yes,” pat yourself on the back, you’re ready for 2020!

One more question, can each of your therapists and assistants say “Yes” to each of these questions?

The 2020 CMS Assistant Modifiers are yet another audit trap that our industry is glossing over. It’s true that the 15% assistant discounts don’t hit until 2022, but if your January 2 notes aren’t compliant with the above scenarios, you’re likely to see takebacks when audited.

Suggestion: Let’s keep things simple.

In the blink of an eye, Systems 4PT recommends assistant modifiers and unit charges as well as

written defense of “who provided how much content” for each CPT code.

Proceeding by manually parsing out therapist vs. assistant treatment content and then manually documenting the same detail for each CPT code is wrong-headed. It’s not your job.

Your job is to restore the patient’s functional deficits.

New for 2020, Systems 4PT’s technology intuitively segregates therapist treatment content from assistant provided services. Our automation instantly recommends the defendable unit charges and applies those charges to the appropriate provider with the compliant modifier, cognizant of CMS, vs. AMA coding requirements, and complete with specificity detailing “who provided what services.”

When documenting a Medicare evaluation with Systems 4PT, patient-specific documentation appears “touch-free” for the 12 evaluation topics listed below:

Patient’s Greatest Concern
Prior Level of Function
Pain Scale
Outcome Test Name, Date, and Score
Medical History
Current Medications, Dosage, Frequency, and Route of Intake
Your unique 20-50 Row Treatment Plan, Archived From Your Diagnosis and Risk Factor Specific Library
Primary Functional Deficit With Forecasted Ending Severity
Functional Goals That Relate to the Primary Deficit
Defense of the Severity of the Eval Code
Clinical Rationale Defending Every CPT Code in the Treatment Plan, Relative to the Primary Functional Deficit
And for 2020: Defensive documentation that details which provider delivered how much of each exercise, treatment, and modality, complete with appropriate assistant modifiers