CATEGORY
Physical medicine and rehabilitation therapeutic Procedures
CODE TYPE
Timed-based code
Billed in 15 minutes increment
ADD-ON CODE
No add-on code
SENSORY INTEGRATIVE TECHNIQUES
Patients with Sensory processing disorder (SPD) are not able to process sensory information coming from different sensory organs (touch, movement, smell, touch, taste and hearing) correctly.
There are 3 types of SPD:
- Sensory modulation Disorder
- Sensory Discrimination Disorder
- Sensory Based Motor Disorder
Sensory Integration Therapy works by exposing the patients to sensory stimulation (vestibular, proprioceptive and tactile) in a structured and repetitive manner so that overtime the brain will adapt and will learn to response to sensations appropriately and in an organized way. They are especially useful in children with autism spectrum disorders. Children with SPD may be hypersensitive or under sensitive to certain stimuli like noise.
Sensory Integration Therapy may include techniques:
- Textured mitts
- balance treatments
- movement therapy
- sensory diet plan
- structured exposure to sensory input
- Accommodations and adaptations
- Deep Pressure joint Compression Exercises
- Weighted vests
- Body massage
- Body brushing
- Oral motor Exercise
- Social Stimulation
CODING GUIDELINES
- One-on-one therapy code
- Initial 15 minutes of cognitive therapy
- Require a therapy modifier (GP, GN, GO, CO, CQ)
- CMS 8-minute and AMA rule of Eights are applied
CMS 8-Minute Rule:
A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97533 to be billed.
| Units | Number of Minutes |
|---|---|
| 1 unit | ≥ 08 minutes through 22 minutes |
| 2 units | ≥ 23 minutes through 37 minutes |
| 3 units | ≥ 38 minutes through 52 minutes |
| 4 units | ≥ 53 minutes through 67 minutes |
| 5 units | ≥ 68 minutes through 82 minutes |
| 6 units | ≥ 83 minutes through 97 minutes |
| 7 units | ≥ 98 minutes through 112 minutes |
| 8 units | ≥ 113 minutes through 127 minutes |
The pattern remains the same for treatment times of more than 2 hours.
AMA Rule of Eights:
“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”
PHYSICAL THERAPY MODIFIERS
Below mentioned modifiers are used when services are provided for the respective plan of care:
| MODIFIERS | PLAN OF CARE |
|---|---|
| GP | Outpatient Physical Therapy |
| GO | Outpatient Occupational Therapy |
| GN | Outpatient Speech-Language Pathology |
| CQ | Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially) |
| CO | Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially) |
TOTAL NO. OF BILLABLE UNITS
04 units are allowed per date of service by CMS but more can be billed if justified by medical notes .
MEDICAL NECESSITY
Medically necessity is considered in diseases or illness which cause functional physical/cognitive disabilities in patients:
- Autism
- developmental delay
- Attention deficit disorder
- Brain injuries
- Other neurological condition
REIMBURSEMENT GUIDELINES
For reimbursement following elements must be documented the Physical Therapy Notes:
- Documentation of medical condition to justify medical necessity of Sensory Integration Therapy
- Total direct time spent by the provider with patient
- In order to meet coverage criteria, therapy services must have these requirements in common:
- Patient condition has the potential to improve
- Documentation of improvement from therapy using objective assessment tools and measurements and functional accomplishments
- Therapy is not being provided to treat loss of function in conditions that are transient and expected to resolve spontaneously reversible
- Therapy plan must be developed by a qualified/certified healthcare professional
