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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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  • Arkansas Speech Therapy Scope of Practice

    23 Nov 2021 4:20 PM | Zachary Edgar (Administrator)

    Scope of Practice

    How is the practice of speech language pathology defined in Arkansas?

    “Speech-language pathology” means the application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, counseling, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language, and dysphagia for the purpose of evaluating, preventing, ameliorating, or modifying such disorders and conditions in individuals and groups of individuals.

    What is included in the practice of speech-language pathology?

    Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of:

    • Speech (i.e., articulation, fluency, resonance, and voice including aeromechanical components of respiration);
    • Language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects of communication) including comprehension and expression in oral, written, graphic, and manual modalities; language processing, preliteracy and language-based literacy skills, including phonological awareness;
    • Swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events (evaluation of esophageal function is for the purpose of referral to medical professionals);
    • Cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions);
    • Sensory awareness related to communication, swallowing, or other upper aerodigestive functions.

    Establishing augmentative and alternative communication techniques and strategies including developing, selecting, and prescribing of such systems and devices (e.g., speech generating devices).

    Providing services to individuals with hearing loss and their families/caregivers (e.g., auditory training, speechreading, speech and language intervention secondary to hearing loss, visual inspection and listening checks of amplification devices for the purpose of troubleshooting, including verification of appropriate battery voltage).

    Screening hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screening for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management.

    Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy, computer technology) to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions in accordance with the principles of evidence-based practice.

    Selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves, electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.

    Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitive communication disorders.

    Educating and counseling individuals, families, co-workers, educators, and other persons in the community regarding acceptance, adaptation, and decision making about communication, swallowing, or other upper aerodigestive concerns.

    Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full participation in communication, including the elimination of societal barriers.

    Collaborating with and providing referrals and information to audiologists, educators, and health professionals as individual needs dictate.

    Addressing behaviors (e.g., perseverative or disruptive actions) and environments (e.g., seating, positions for swallowing safety or attention, communication opportunities) that affect communication, swallowing, or other upper aerodigestive functions.

    Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice, care and improvement of the professional voice, personal/professional communication effectiveness).

    Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse cultural backgrounds and adjust treatment and assessment services accordingly.

    What is specifically excluded from the practice?

    N/A

    Are there any special trainings or requirements?

    N/A

    Reference

    A.C.A. § 17-100-103

    Ark Rules Board of Examiners in Speech-Language Pathology § 11


  • Medicare Therapy Documentation Changes

    13 Nov 2021 11:04 AM | Zachary Edgar (Administrator)

    Sample Audit Form - Can be used to audit outpatient therapy documentation. 

    General Documentation Requirements

    • Document Requirements
    • The Patient is under the Care of a Physician/NPP
    • Services Require the Skills of a Therapist
    • Services are of Appropriate Type, Frequency, Intensity and Duration 
    • Needs of the Patient
    • Dictated Documentation
    • Dates for Documentation

    Evaluations

    • When it is Appropriate for an Initial Evaluation
    • Contents of an Evaluation
    • When the Evaluation is the Only Service Provided
    • When the Evaluation Serves as the Plan of Care
    • Additional Assessments
    • Evaluations by Multiple Disciplines

    Plan of Care

    • Establishing the Plan of Care
    • Elements of the Plan of Care
    • Modifying the Plan of Care

    Certification and Re-certification of the Treatment Plan

    • What does it mean to have the plan of care certified?
    • Do I need an order/prescription/referral from a physician/NPP?
    • When does the POC need to be certified?
    • Is the initial treatment date when I began treating the patient or when I performed the evaluation?
    • How long do certifications last?
    • What happens if I can’t get the plan certified within ninety (90) days?
    • Do I need to submit additional evidence to justify the delay?
    • Who must certify the POC?
    • Which practitioners are not allowed to certify a plan of care?
    • Can I have the physician/NPP sign a document other than the POC?
    • Are verbal certifications acceptable?
    • When does the POC need to be recertified?
    • What happens if the recertification is delayed?
    • What happens if my claim is denied due to certification issues?

    Progress Reports 

    • Timing of the Progress Report
    • Content of the Progress Report
    • Clinician’s Participation in the Report
    • Assistant’s Participation in the Report

    Treatment Notes

    • Required Elements
    • Optional Elements
    • Additional Tips for Notes
    • Making Changes to the Note
    • Signature on the Note
    • Identification of the Supervisor

    Reevaluations

    • Who may Perform a Reevaluation?
    • Role of the Assistant
    • When can a Reevaluation be Performed?
    • Reimbursement
    • Content of the Reevaluation
    • Billing for a Reevaluation
    • Documentation

    Discharge Summary

    • What is Required in the Discharge Note?
    • Unanticipated Discharge
    • Optional Information

      Medicare Signature Requirements

      • Which outpatient therapy documentation requires and signature and who must sign?
      • What is required for a valid signature?
      • What if I use a scribe when documenting medical record entries?
      • How are orders treated differently than other medical documentation?
      • What should I do if I did not sign an order or medical record?
      • What if I signed the order or progress note but my signature is not legible?
      • What is a signature log?
      • What if I do not have a signature log in place?
      • Am I able to attest to my signature?
      • Do my signatures need to be dated?


    • Arkansas Occupational Therapy Scope of Practice

      2 Nov 2021 4:17 PM | Zachary Edgar (Administrator)

      How is the practice of occupational therapy defined in Arkansas?

      “Occupational therapy” means the evaluation and treatment of individuals whose ability to cope with the tasks of living is threatened or impaired by developmental deficits, the aging process, poverty or cultural differences, environmental or sensory deprivation, physical injury or illness, or psychological and social disability.

      What is included in the practice of occupational therapy?

      Occupational therapy treatment utilizes task-oriented activities to prevent or correct physical or emotional deficits or to minimize the disabling effect of these deficits in the life of the individual so that he or she might perform tasks normally performed at his or her stage of development.

      Specific occupational therapy techniques include, but are not limited to:

      • Instruction in activities of daily living, design, fabrication, application, recommendation, and instruction in the use of selected orthotic or prosthetic devices and other adaptive equipment;
      • Perceptual-motor and sensory integrative activities;
      • The use of specifically designed crafts;
      • Exercises to enhance functional performance; and
      • Prevocational evaluation and treatment.

      Services specifically excluded from the scope of practice

      N/A

      Are there any specific procedures or modalities regulated by the board?

      N/A

      Reference

      AR Code § 17-88-102

    • Arkansas Physical Therapy Scope of Practice

      2 Nov 2021 4:15 PM | Zachary Edgar (Administrator)

      How is physical therapy defined in Arkansas?

      Examining and evaluating patients with mechanical, physiological, and developmental impairments, functional limitations, and disability or other health-related conditions in order to determine a physical therapy diagnosis, prognosis, and planned therapeutic intervention.

      What is included in the practice of physical therapy?

      Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include:

      • Therapeutic exercise;
      • Functional training in self-care as it relates to patient mobility and community access;
      • Manual therapy techniques, including soft tissue massage, manual traction, connective tissue massage, therapeutic massage, and mobilization, i.e., passive movement accomplished within normal range of motion of the joint, but excluding spinal manipulation and adjustment;
      • Assistive and adaptive devices and equipment as they relate to patient mobility and community access;
      • Physical agents;
      • Mechanical and electrotherapeutic modalities; and
      • Patient-related instruction.

      Preventing injury, impairments, functional limitations, and disability, including the promotion and maintenance of fitness, health, and quality of life in all age populations; and

      Engaging in consultation, testing, education, and research.

      What is specifically excluded from the practice?

      The therapeutic intervention of bronchopulmonary hygiene and debridement of wounds require a physician referral before initiation of treatment.

      Physical therapy does not include radiology or electrosurgery.

      Are there any special trainings required?

      N/A

      Reference

      Ark. Code Ann. § 17-93-102

    • Alabama Speech Therapy Scope of Practice

      24 Oct 2021 2:47 PM | Zachary Edgar (Administrator)

      How does Alabama define the practice of speech-language pathology?

      “Speech‐Language Pathology,” the application of principles, methods and procedures related to the development, disorders and effectiveness of human communication and related functions including but not limited to providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling and follow‐up services for disorders of speech (i.e. articulation, fluency, resonance and voice), language (i.e., phonology, morphology, syntax, pre‐literacy and language‐based literacy skills), swallowing or other upper aerodigestive functions; and cognitive aspects of communication (i.e. attention, memory, problem solving).

      What is included in the practice of speech-language pathology?

      Providing screening, identification, assessment, diagnosis, treatment, intervention (i.e. prevention, restoration, amelioration, compensation) and follow‐up services for disorders of:

      • Speech: articulation, fluency, voice (including respiration, phonation, and resonance)
      • Language (involving the parameters of phonology, morphology, syntax, semantics, and pragmatics; and including disorders of receptive and expressive communication in oral, written, graphic, and manual modalities)
      • Oral, pharyngeal, cervical esophageal, and related functions, (e.g. dysphagia, including disorders of swallowing and oral function of feeding; orofacial myofunctional disorders)
      • Cognitive aspects of communication (including communication disability and other functional disabilities associated with cognitive impairment)
      • Social aspects of communication (including challenging behavior, ineffective social skills, lack of communication opportunities).

      Providing consultation and counseling and making referrals when appropriate.

      Training and supporting family members and other communication partners of individuals with speech, voice, language communication, and swallowing disabilities.

      Developing and establishing effective augmentative and alternative communication techniques and strategies, including selecting, prescribing, and dispensing aids and devices and training individuals, their families, and other communication partners in their use.

      Selecting, fitting, and establishing effective use of appropriate prosthetic/adaptive devices for speaking and swallowing (e.g. tracheoesophageal valves, electrolarynges, speaking valves).

      Using instrumental technology to diagnose and treat disorders of communication and swallowing (e.g., videofluoroscopy, nasenodoscopy, ultrasonography, stroboscopy).

      Providing aural rehabilitation and related counseling services to individuals with hearing loss and their families.

      Collaborating in the assessment of central auditory processing disorders in cases in which there is evidence of speech, language, and/or other cognitive‐ communication disorders; providing intervention for individuals with central auditory processing disorders.

      Conducting pure tone air conduction hearing screening and screening tympanometry for the purpose of the initial identification and/or referral of individuals with other communication disorders or possible middle ear pathology.

      Enhancing speech and language proficiency and communication effectiveness, including but not limited to accent reduction, collaboration with teachers of English as a second language, and improvement of voice, performance, and singing.

      Training and supervising support personnel.

      Developing and managing academic and clinical programs in communication sciences and disorders.

      Conducting, disseminating, and applying research in communication sciences and disorders.

      Measuring outcomes of treatment and conducting continuous evaluation of the effectiveness of practices and programs to improve and maintain quality of services.

      Special practice areas

      N/A

      Reference

      Ala. Code § 870‐X‐1‐.01

      Ala. Code § 870‐X‐7‐.02


    • Alabama Occupational Therapy Scope of Practice

      24 Oct 2021 2:45 PM | Zachary Edgar (Administrator)

      How is occupational therapy defined in Alabama?

      The practice of occupational therapy means the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings.

      Occupational therapy services are provided for habilitation, rehabilitation, and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction.

      Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life.

      What is included in the practice of occupational therapy?

      Evaluation of factors affecting activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

      • Client factors, including body functions, such as neuromusculoskeletal, sensoryperceptual, visual, mental, cognitive, and pain factors; body structures such as cardiovascular, digestive, nervous, integumentary, genitourinary systems, and structures related to movement; values, beliefs, and spirituality.
      • Habits, routines, roles, rituals, and behavior patterns.
      • Physical and social environments, cultural, personal, temporal, and virtual contexts, and activity demands that affect performance.
      • Performance skills, including motor and praxis, sensory-perceptual, emotional regulation, cognitive, communication, and social skills.

      Methods or approaches selected to direct the process of interventions such as:

      • Establishment, remediation, or restoration of a skill or ability that has not yet developed, is impaired, or is in decline.
      • Compensation, modification, or adaptation of activity or environment to enhance performance, or to prevent injuries, disorders, or other conditions.
      • Retention and enhancement of skills or abilities without which performance in everyday life activities would decline
      • Promotion of health and wellness, including the use of self-management strategies, to enable or enhance performance in everyday life activities.
      • Prevention of barriers to performance and participation, including injury and disability prevention.

      Interventions and procedures to promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), rest and sleep, education, work, play, leisure, and social participation including all of the following:

      • Therapeutic use of occupations, exercises, and activities.
      • Training in self-care, self-management, health management and maintenance, home management, community/work reintegration, and school activities and work performance.
      • Development, remediation, or compensation of neuromusculoskeletal, sensory-perceptual, visual, mental, and cognitive functions, pain tolerance and management, and behavioral skills.
      • Therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process.
      • Education and training of individuals, including family members, caregivers, groups, populations, and others.
      • Care coordination, case management, and transition services.
      • Consultative services to groups, programs, organizations, or communities.
      • Modification of environments, including home, work, school, or community, and adaptation of processes, including the application of ergonomic principles.
      • Assessment, design, fabrication, application, fitting, and training in seating and positioning, assistive technology, adaptive devices, training in the use of prosthetic devices, orthotic devices, and the design, fabrication and application of selected splints or orthotics.
      • Assessment, recommendation, and training in techniques to enhance functional mobility, including management of wheelchairs and other mobility devices.
      • Low vision rehabilitation when the patient or client is referred by a licensed optometrist, a licensed ophthalmologist, a licensed physician, a licensed assistant to physician acting pursuant to a valid supervisory agreement, or a licensed certified registered nurse practitioner in a collaborative practice agreement with a licensed physician.
      • Driver rehabilitation and community mobility.
      • Management of feeding, eating, and swallowing to enable eating and feeding performance.
      • Application of physical agent modalities, and use of a range of specific therapeutic procedures such as wound care management, interventions to enhance sensory-perceptual and cognitive processing, and manual therapy, all to enhance performance skills.
      • Facilitating the occupational performance of groups, populations, or organizations through the modification of environments and the adaptation of processes.

      What is specifically excluded from the practice?

      N/A

      Are there any special trainings or requirements?

      N/A

      Reference

      Ala. Code §34-39-3

    • Alabama Physical Therapy Scope of Practice

      24 Oct 2021 2:42 PM | Zachary Edgar (Administrator)

      How is the practice of Physical Therapy defined in Alabama?

      The treatment of a human being by the use of exercise, massage, heat, cold, water, radiant energy, electricity, or sound for the purpose of correcting or alleviating any physical or mental condition or preventing the development of any physical or mental disability, or the performance of neuromuscular-skeletal tests and measurements to determine the existence and extent of body malfunction.

      What services are included in the scope of practice?

      N/A

      Services specifically excluded from the scope of practice

      Physical therapy does not include radiology or electrosurgery.

      Are there any specific procedures or modalities regulated by the board?

      Yes. October 23, 2007: Board Minutes: Acupuncture & Dry Needling does fall within the scope of practice for physical therapy.

      Reference

      Ala. Code 34-24-191


    • Arizona Speech Therapy Scope of Practice

      14 Oct 2021 3:49 PM | Zachary Edgar (Administrator)

      How does Arizona define the practice of speech-language pathology?

      "Speech-language pathology" means the nonmedical and nonsurgical application of principles, methods and procedures of assessment, testing, evaluation and prediction related to speech and language and its disorders and related communication impairments for the nonmedical diagnosis, prevention, amelioration or modification of these disorders and conditions.

      What is included in the practice of speech-language pathology?

      The practice of speech-language pathology in Arizona includes:

      • Rendering or offering to render to an individual or groups of individuals who have or are suspected of having disorders of communication service in speech-language pathology including prevention, identification, evaluation, consultation, habilitation, rehabilitation, instruction and research.
      • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating disorders of speech and language.
      • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating disorders of oral-pharyngeal functions and related disorders.
      • Screening, identifying, assessing, interpreting, nonmedical diagnosing and rehabilitating cognitive and communication disorders.
      • Assessing, selecting and developing augmentative and alternative communication systems and providing training in the use of these systems and assistive listening devices.
      • Providing aural rehabilitation and related counseling services to hearing impaired persons and their families.
      • Enhancing speech-language proficiency and communication effectiveness.
      • Screening hearing and other factors for speech-language evaluation and initially identifying persons with other communication disorders and making the appropriate referral.

      What is specifically excluded from the practice?

      N/A

      Are there any certifications required for specific practices?

      N/A

      Reference

      A.R.S. § 36-1901


    • Arizona Occupational Therapy Scope of Practice

      14 Oct 2021 3:46 PM | Zachary Edgar (Administrator)

      How is occupational therapy defined in Arizona?

      "Occupational therapy" means the use of therapeutic activities or modalities to promote engagement in activities with individuals who are limited by physical or cognitive injury or illness, psychosocial dysfunction, developmental or learning disabilities, sensory processing or modulation deficits or the aging process in order to achieve optimum functional performance, maximize independence, prevent disability and maintain health. Occupational therapy includes evaluation, treatment and consultation based on the client's temporal, spiritual and cultural values and needs.

      What is included in the practice of occupational therapy?

      Occupational therapy services in Arizona includes the following:

      • Developing an intervention and training plan that is based on the occupational therapist's evaluation of the client's occupational history and experiences, including the client's daily living activities, development, activity demands, values and needs.
      • Evaluating and facilitating developmental, perceptual-motor, communication, neuromuscular and sensory processing function, psychosocial skills and systemic functioning, including wound, lymphatic and cardiac functioning.
      • Enhancing functional achievement, prevocational skills and work capabilities through the use of therapeutic activities and modalities that are based on anatomy, physiology and kinesiology, growth and development, disabilities, technology and analysis of human behavioral and occupational performance.
      • Evaluating, designing, fabricating and training the individual in the use of selective orthotics, prosthetics, adaptive devices, assistive technology and durable medical equipment as appropriate.
      • Administering and interpreting standardized and nonstandardized tests that are performed within the practice of occupational therapy, including manual muscle, sensory processing, range of motion, cognition, developmental and psychosocial tests.
      • Assessing and adapting environments for individuals with disabilities or who are at risk for dysfunction.

      What is specifically excluded from the practice?

      N/A

      Are there any special trainings or requirements?

      N/A

      Reference

      A.R.S. § 32-3401

    • Arizona Physical Therapy Scope of Practice

      14 Oct 2021 3:44 PM | Zachary Edgar (Administrator)

      How is the practice of physical therapy defined in Arizona?

      Examining, evaluating and testing persons who have mechanical, physiological and developmental impairments, functional limitations and disabilities or other health and movement related conditions in order to determine a diagnosis, a prognosis and a plan of therapeutic intervention and to assess the ongoing effects of intervention.

      What is included in the practice of physical therapy?

      Alleviating impairments and functional limitations by managing, designing, implementing and modifying therapeutic interventions including:

      • Therapeutic exercise.
      • Functional training in self-care and in home, community or work reintegration.
      • Manual therapy techniques.
      • Therapeutic massage.
      • Assistive and adaptive orthotic, prosthetic, protective and supportive devices and equipment.
      • Pulmonary hygiene.
      • Debridement and wound care.
      • Physical agents or modalities.
      • Mechanical and electrotherapeutic modalities.
      • Patient related instruction.

      Reducing the risk of injury, impairments, functional limitations and disability by means that include promoting and maintaining a person's fitness, health and quality of life.

      Engaging in administration, consultation, education and research.

      Services specifically excluded from the scope of practice

      N/A

      Are there any special trainings required?

      Arizona PT Dry Needling

      Reference

      A.R.S. § 32-2001

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