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OT564 Final Review Sheet

Outcome and Assessment Status Information Set (OASIS)

Used in home health

ICD-9, ICD-10 (International classification of diseases) codes

Codes required by CMS for all claims after 10/2013. Most codes have 3 to 7 digits (e.g. ICD-10 Multiple Sclerosis=G35)

ICD-9, ICD-10 (International classification of diseases) codes

Improve ability to measure health care services, increase sensitivity when refinining grouping and reimbursement methodologies, and decrerase need to include supporting documentation with claims.

ICD-9, ICD-10 (International classification of diseases) codes

Assigned to every disorder of body structure and function and to some activity limitations but not to participation restricitions

CPT (Current procedural terminology) codes

Used by virtually all 3rd party payers.

CPT (Current procedural terminology) codes

Specific codes cannot be used together if they are mutually exclusive or comprehensive

CPT (Current procedural terminology) codes

Codes for most OT services are found in Physical Medicine and Rehabilitation Section 97000 series

CPT (Current procedural terminology) codes

Grouped into Evaluation, Procedures and Modalities

CPT (Current procedural terminology) codes

Codes may be Time Based (charge for each 15 minutes of service provided) or untimed (one unit regardless of how long the service lasts)

CPT (Current procedural terminology) codes

Group Therapeutic Procedure and modalities are untimed - can be billed only 1 unit per date of service

CPT (Current procedural terminology) codes

Usually 5 digits, sometimes a letter. For example, ADLs = 97535

Level I HCPCS (Healthcare common procedure coding system)

Same as CPT Codes.

Level II HCPCS codes (Healthcare common procedure coding system)

Created by CMS to address services, equipment and supplies that are not included in the CPT codes.

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