Why have a physical medicine charges reviewed?

Physical Medicine Charges: These charges need to be reviewed when going to trial.

Physical Medicine includes physical/occupational therapy, chiropractic, acupuncture, and massage. These are common therapies someone can receive when being treated for an injury, or recovering from surgery. While the costs of the services themselves are much smaller compared to hospital and surgery fees, the total cost for these treatments can make a large difference in a requested settlement amount.
When a person is receiving these therapies, it is common for each visit will consist of multiple modalities or CPT codes that are billed on each date. In addition to the multiple modalities being rendered, a treatment plan may consist of multiple visits per week, month, etc. over the course of months or even years. This is why physical medicine charges are important to consider when performing a Medical Billing Review.
The CPT codes used in therapies, chiropractic, and acupuncture have their own rules. Some of the codes are time-based. This means that time spent on the modality must be documented in the medical record. If time is not documented, the code is not valid to be charged.
Some of the CPT codes are based on body areas being treated. A common chiropractic CPT is 98940. This code is for spinal manipulation of 1-2 spinal areas. If the 1-2 areas are not documented in the medical record, CPT 98940 is not valid to be charged.
These are just a few examples of why you need a knowledge of coding rules and guidelines to successfully review medical billing. Other problems I come across are charging for services and products never rendered, as well as not having a medical record to justify the charges.
It is recommended that when having a Medical Billing Review completed that all charges for all services rendered along with the entire medical record be submitted to the Medical Billing Expert Witness for consideration. As you can see, it is crucial that your Expert Witness have the knowledge and experience to consolidate the medical bills against the medical record, and to know and understand the current medical coding guidelines to ensure accurate coding is used. At Medical Reimbursement Experts, we have that necessary knowledge and experience.