Title: Section 447.4 - Physical therapy services

Effective Date

12/23/1980

447.4 Physical therapy services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7510 Physical Therapy

(1) The standard unit of measure will be the relative value units developed by the American Physical Therapy Association. Relative value units shall be counted during a patient visit for all cost center activities for which a charge is made. A patient visit is the occasion for service during which the resources of the physical therapy cost center are used. A visit is one appearance of a patient regardless of the number of evaluation, therapeutic, patient education activities performed during that appearance.

(2) The two major components of the relative value unit are: personnel time associated with the activity, and other direct and appropriate indirect department resources used in providing the activity. Fifteen minutes has been established as the least increment of time for which a unit of service (e.g., evaluation, therapeutic, or patient educational activity) can occur. The unit of service which requires the least amount of the physical therapy department's total resources is a modality. This activity is used to establish the basic relative value unit of 1.0. Since the basic relative value unit of 1.0 does not require the continuous attendance of physical therapy personnel, the initial unit value for those services that do require the continuous attendance of physical therapy personnel is adjusted upward. An additional .4 of a unit will be added to the initial increment for those activities requiring continuous attendance by physical therapy personnel. When subsequent 15-minute increments of service are provided, some of the initial direct and indirect costs do not recur or are reduced. Therefore, relative value units for subsequent increments of time are approximately 10 percent less than the initial unit value.

(3) The recording of 15-minute increments of service begins with the initiation of the evaluation, therapeutic, or patient educational activity. Although time may have been spent transporting the patient to the department or making entries in the medical record, RVU's are not counted for these activities. Patient transportation, treatment preparation and cleanup, and recordkeeping costs are incorporated in the weighting of the initial 15-minute increment of service and additional RVU's cannot be added for these activities. However, the time required to complete a separate formal report for patient evaluations or aftercare planning can be counted.

(4) Therapeutic or evaluation activities performed in the home shall have a unit value equivalent to that for the appropriate therapeutic or evaluation activity rendered plus an allowance for travel time to and from the home. Travel time for home visits is valued the same as those activities requiring continuous attendance by physical therapy personnel with the patient.
(b) RELATIVE VALUE UNITS
Initial Additional 1515 minutes (round toDescription minutes nearest 15 minutes)
(1) EVALUATION ACTIVITIES
Evaluation activities are assessments of patients' performance toassist in establishing diagnoses orto establish or reevaluatetreatment plans. 1.4 1.3
(2) THERAPEUTIC ACTIVITIES
(i) Modalities
A modality does not require thecontinuous attendance of physicaltherapy personnel during a therapeutics activity 1.0 0.9
(ii) Procedures
A procedure does require the continuousattendance of physical therapy personnelduring a therapeutic activity. 1.4 1.3
(iii) Hydrotherapy
Continuousattendance ofpersonnel
notrequired required
Extremity or Body Whirlpool 1.4 1.3 0.9
Hubbard Tank or Therapeutic Pool 2.5 1.3 0.9
Initial Additional 1515 minutes (round tominutes nearest 15minutes)
(3) PATIENT EDUCATIONAL ACTIVITIES
Patient educational activities are usedto instruct the patient or his attendant,family or their substitute in maintainingand improving the patient's condition. 1.4 1.3
(4) COMBINATION OF EVALUATION, THERAPEUTICOR PATIENT EDUCATIONAL ACTIVITIESMultiple evaluation, therapeutic, patienteducational activities performed duringa patient visit will be reported as acombination.
(i) Any number of modalities in combination 1.0 0.9
(ii) Any number of evaluation, therapeutic,or patient educational activities incombination 1.4 1.3
(iii) Hydrotherapy in combination withother activities:
Extremity or Body Whirlpool 1.4 1.3
Hubbard Tank or Therapeutic Pool 2.5 1.3
(5) HOME VISITS
A home visit is provided to an individualpatient in a setting other than the physicaltherapist's office or work facility. Thestandard unit of measure for home visitsincludes the number of relative value unitsfor the evaluation, therapeutic, or patienteducational activity and for travel time.
(i) Evaluation, Therapeutic, orEducational Activities 1.4 1.3
(ii) Travel Time
Travel time for home visits is the actualtime spent by physical therapy personnelgoing to and from the home. Travel timefor multiple home visits during a singletrip is calculated by dividing the totalnumber of relative value units for traveltime by the number of patients treatedduring that trip. 1.3 1.3
(6) GROUP ACTIVITIES
A group activity is the occasion forservice during which two or more patientssimultaneously receive a therapeutic,evaluation, or patient educationalactivity. Group activities will bereported by counting the number of RVU'sfor one patient participating in thegroup activity session, and adding 0.1RVU per session for each patientparticipating in the group activity. 1.3 1.3
(7) Notes
(i) For further explanation of how to use the relative value units seethe accompanying Schedule of Unit Values and Examples of RelativeValue Unit Computations for Combination Activities.
(ii) When multiple personnel are used during an entire activityperiod, additional 1.3 RVU's are recorded for each person for each15-minute increment.
(iii) The units of measure do not Include wound dressing, debridement,exercise or other activities performed in conjunction with hydrotherapy.
(iv) When computing an indiviudal's RVU's, the value should be roundedto the nearest one-tenth (e.g., 0.62 = 0.6, 0.68 = 0.7).
(c) SCHEDULE OF UNIT VALUES
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.
(1) Evaluation Activities 1.4 1.3 2.7 4.0 5.3
(2) Therapeutic Activities
(i) Modalities 1.0 0.9 1.9 2.8 3.7
(ii) Procedures 1.4 1.3 2.7 4.0 5.3
UNIT VALUE TOTAL VALUES
Initial Additional
Description 15 15 30 45 60min. min. min. min. min.

(iii) Hydrotherapy
Extremity or Body
Whirlpool
Continuous attendanceof personnelrequired 1.4 1.3 2.7 4.0 5.3
not required 1.4 0.9 2.3 3.2 4.1
Hubbard Tank orTherapeutic Pool
Continuous attendanceof personnel
required 2.5 1.3 3.8 5.1 6.4
not required 2.5 0.9 3.4 4.3 5.2
(3) Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(4) Combination of Evaluation,Therapeutic, or PatientEducational Activities
(i) Any Number of Modalitiesin Combination 1.0 0.9 1.9 2.8 3.7
(ii) Any Number of Evaluation,Therapeutic, or PatientEducational Activitiesin Combination 1.4 1.3 2.7 4.0 5.3
(iii) Hydrotherapy inCombination withOther ActivitiesExtremity or BodyWhirlpool 1.4 1.3 2.7 4.0 5.3
Hubbard Tank orTherapeutic Pool 2.5 1.3 3.8 5.1 6.4
(5) Home Visits
(i) Evaluation, Therapeutic,or Patient EducationalActivities 1.4 1.3 2.7 4.0 5.3
(ii) Travel Time 1.3 1.3 2.6 3.9 5.2
(6) Group Activities(total RVU's plus 0.1 persession for each patient) 1.3 1.3 2.6 3.9 5.2Note: Activities that exceed 60 minutes are recorded by adding theappropriate values from the "additional 15 minutes" column.
(d) EXAMPLES OF RELATIVE VALUE UNIT COMPUTATIONS FOR COMBINATIONACTIVITIES
(1) Description Calculations RVU's
(1) MODALITIES
A patient is in the department for 60 minutes.The patient waits 30 minutes before receiving30 minutes of hot packs and cervicaltraction to the neck. 1.0 + 0.9 = 1.9
(2) PROCEDURES
Therapeutic exercise to the right legand gait training for 1.4 + 1.3 + 1.3 = 4.0
45 minutes.
(3) EVALUATION AND MODALITIES/PROCEDURES
Evaluation, hot pack, ultrasound,and massage to the left shoulderfor 75 minutes. 1.4 + 1.3 + 1.3 +
1.3 + 1.3 = 6.6
(4) HYDROTHERAPY
(i) Extremity whirlpool, not requiringcontinuous attendance of physicaltherapy personnel, 30 minutes. 1.4 + 0.9 = 2.3
(ii) Therapeutic pool, requiring continuousattendance of physical therapypersonnel, 45 minutes. 1.4 + 1.3 + 1.3 = 4.0
(5) HYDROTHERAPY COMBINATIONS
(i) Extremity whirlpool massage andexercise to the left arm for 60minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(ii) Body whirlpool and exercise to bothlegs and back for 60 minutes. 1.4 + 1.3 + 1.3
+ 1.3 = 5.3
(iii) Hubbard tank and burn debridementto upper torso for 60 minutes with onestaff member required; 2.5 + 1.3 + 1.3
+ 1.3 = 6.4
with two staff members required. (2.5 + 1.3 + 1.3 +
1.3) + (1.3 + 1.3 +
1.3 + 1.3) = 11.6
(6) HOME VISIT
(i) A visit is made to a patient's homeand 25 minutes of diathermy is provided.A visit is then made to another patient'shome and 35 minutes of gait trainingis provided. Travel time to and from thehospital as well as between the twohomes is 45 minutes.
(ii) The RVU's for travel time per homevisit are the total number of RVU'sfor travel time divided by the totalnumber of home visits. 1.3 + 1.3 +
1.3 = 3.9
3.9 -2.0 = 1.95
or 2.0 2.0
(iii) First visit: Diathermy treatmentfor 25 minutes. 1.4 + 1.3 = 2.7
Total RVU's for first 2.0 + 2.7 = 4.7
home visit.
(iv) Second visit: Gait training for35 minutes. 1.4 + 1.3 = 2.7
Total RVU's for second 2.0 + 2.7 = 4.7home visit
(7) GROUP ACTIVITIES
(i) Ten patients received exerciseinstruction and patient education. Theactivity session was 35 minutes inDuration.
(ii) One staff member required. (1.3 + 1.3) +
(0.1 x 10) = 3.6
(Average RVU's
per patient =
0.36 or 0.4
(iii) Two staff members required. (1.3 + 1.3) +
(1.3 + 1.3) +
(1.3 + 1.3) = 6.2
(10 x 0.1)
(Average RVU's
per patient =
0.62 or 0.6)

Volume

VOLUME C (Title 10)

up