Billing for massage in a PT clinic

[fozzy40]

There is a rehab clinic that I frequently refer to that has a combination of PT, OT, and LMP. My scripts specify for therapeutic exercise but I often get initial evals for both PT and massage therapy. I do not want massage therapy to be done in combination with PT.

My question (knowing the PT and massage is not the same) is how does billing typically work? Do the massage visits count with the PT visits? I see two different initial evaluations so I will assume that they are separate bills.

Thanks for your help!

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[Fiveoboy11]

There is a rehab clinic that I frequently refer to that has a combination of PT, OT, and LMP. My scripts specify for therapeutic exercise but I often get initial evals for both PT and massage therapy. I do not want massage therapy to be done in combination with PT.

My question (knowing the PT and massage is not the same) is how does billing typically work? Do the massage visits count with the PT visits? I see two different initial evaluations so I will assume that they are separate bills.

Thanks for your help!

I don't know how the billing is working at that particular clinic and I agree that "massage therapy" is useless is many cases especially with the lofty benefits and claims I've seen/heard.

Perhaps you should consider this - maybe the patient was offered massage from a LMT and he/she elected to try it. Don't you think it is the patient's decision? What is up with physician's trying to dictate everything. Does it matter what you "want"? When you refer someone to a physical therapist do you think it's like you're going to the drive thru at McDonald's and you get what you want?

Further, why are you specifying therapeutic exercise on a script? What does that do, and how is that helpful? That's like someone referring to you with a script that says "medication, imaging." Why don't physician's just refer with what they think the diagnosis is? I know I can be a bit redundant and sound like a broken record but I just don't get that. Kind of insulting from my perspective.

 

[fozzy40]

Does it matter what you "want"?

It does when I have sign off on things.

Kind of insulting from my perspective.

Everything any medical student and/or physician says insults you!

So getting back to the billing...thoughts?

 

[kptnau]

Massage does have benefits, although not as extensive as some may have claimed. Among them are temporary relief of symptoms that is easily visible.

If the patient wants it, the insurance agrees to cover it, and the therapist wants to give it, what's the problem? It's not hurting anyone. At the least it sometimes serves as a temporary relief for the patients.

As far as billing goes, PT's include it with their regular billing I'm pretty sure. So I don't know why there are two evals.

 

[jesspt]

There is a rehab clinic that I frequently refer to that has a combination of PT, OT, and LMP. My scripts specify for therapeutic exercise but I often get initial evals for both PT and massage therapy. I do not want massage therapy to be done in combination with PT.

My question (knowing the PT and massage is not the same) is how does billing typically work? Do the massage visits count with the PT visits? I see two different initial evaluations so I will assume that they are separate bills.

Thanks for your help!

Fozzy,

If a PT performed massage, it could be billed as 97140 (manual therapy). But, this is not a PT specific code - only PT evaluation and PT re-evaluation are specific to PT and must be performed by a licensed PT. I think that billing gets a little less black and white when you are talking about codes other than those two. I would suppose that in some instances, a PT could determine that a patient might benefit from soft-tissue mobilization and then refer to the in-house LMT for that portion of their treatment, and then bill the patients insurance company for manual therapy. This would of course depend on the state practice act, and I am not familiar with Oregon's particular legalities in this regard.

Honestly, I don't know why you are getting two evaluations from two seperate providers - doesn't make sense. If the patient is under the care of the PT that you referred them to, then the evaluation from the LMT is uneccesary. If they are truly being seen individually by two seperate providers, I think it is possible that the patient may be billed seperately for the two services. My concerns in the latter scenario would be as follows:

1. The patient may be paying more out of their pocket to line the pocket of the clinic owner
2. Massage is obviously a passive treatment modiality and a fairly large body of research indicates that active interventions are important for musculoskeletal conditions
3. LMTs have a tendency to think, and educate their patients about, outdated memes that have been persisten in rehab and other types of body work.

Your best bet is to pick up the phone and call the clinic owner. If you are a valued referral source, the owner will be on the phone quickly and you can discuss this with them. If they don't get back to you, well that may tell you all you need to know.

 

[fozzy40]

Thanks for everyone's input. I have no objections to massage therapy but in this particular case the patient is on work comp and trying to get back to work. I've never personally seen massage help someone get back to work with the the type of patient I'm seeing. Very low side effects and risk with massage but I personally don't like most massive modalities when the outcome measure is return to work.

 

[markelmarcel]

If a PT performed massage, it could be billed as 97140 (manual therapy).

That's how it was billed at my first clinical experience.

 

[NewDPT31]

In washington state we used a LMT at our clinic. We saw the occasional work comp patient and for the most part I didn't really see the point for the massage part. However, s/p rotator cuff surgery or a scapular injury...it actually really helped with the muscle guarding. The LMT would see him first, and then he would come straight into PT. Saved me the time and allowed the patient to actually tolerate the treatment session. (of note-this is after the Passive ROM phase ended and we wanted active scapular control).

 

[fozzy40]

Just as follow up, the patient said that he had 3 sessions of massage prior to me signing off on that part of the treatment plan. Does the patient them incur the cost or does the clinic eat the cost?

 

[NewDPT31]

Depends on the date of the script. If they requested it on the day of the first visit(and they dated it that day), and you are just getting around to signing off on it...then they will all count and insurance will pay(if it pays for massage). Usually what we do as PTs is get a script for eval and treat, and then maybe something like "shoulder", "use heat". So we change it and in our eval write a new plan of care with treatment dx code, quantity and codes we will use. And then we write:"if you agree, sign here", or "Change of recommendation". Then when the MD signs it he can say no massage or what not.

Back to your original point. If you change it and say no massage, 9/10 times the financial burden is going to be on the patient. They sign a sheet at the beginning that says if insurance doesn't cover it, then they are on the hook. The clinic might offer them a discount, if only to not piss off the patient and MD and lose their business.

 

[fozzy40]

Depends on the date of the script. If they requested it on the day of the first visit(and they dated it that day), and you are just getting around to signing off on it...then they will all count and insurance will pay(if it pays for massage). Usually what we do as PTs is get a script for eval and treat, and then maybe something like "shoulder", "use heat". So we change it and in our eval write a new plan of care with treatment dx code, quantity and codes we will use. And then we write:"if you agree, sign here", or "Change of recommendation". Then when the MD signs it he can say no massage or what not.

Back to your original point. If you change it and say no massage, 9/10 times the financial burden is going to be on the patient. They sign a sheet at the beginning that says if insurance doesn't cover it, then they are on the hook. The clinic might offer them a discount, if only to not piss off the patient and MD and lose their business.

I figured it was going to be something like that. I never signed the initial evaluation by the massage therapist. They even called me twice to confirm. That's really unfortunate and I hope the clinic does the right thing.

Thanks for your insight!

 

[fozzy40]

Other quick question...apparently the patient has a "nodule" of the lumbar spine. "Continue flexion bias lumbar stabilization and nodule remodeling." Is nodule remodeling usually a treatment objective?

 

[jesspt]

Stop sending patients here. That sounds like total woo. If this nodule exists, the odds of it being a significant contibutor to your patient's pain is almost zero.

 

[BlueBlue8]

I don't know if that is a bad way of saying "trigger points".