N.Y. Comp. Codes R. & Regs. Tit. 10 § 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 Description Initial Additional 15 15 minutes (round to minutes nearest 15 minutes) (1) EVALUATION ACTIVITIES Evaluation activities are 1.4 1.3 assessments of patients' performance to assist in establishing diagnoses or to establish or reevaluate treatment plans. (2) THERAPEUTIC ACTIVITIES (i) Modalities A modality does not require the 1.0 0.9 continuous attendance of physical therapy personnel during a therapeutic activity (ii) Procedures A procedure does require the 1.4 1.3 continuous attendance of physical therapy personnel during a therapeutic activity. (iii) Continuous attend Hydrotherapy attendance of personnel requir- not ed required Extremity or Body Whirlpool 1.4 1.3 0.9 Hubbard Tank or Therapeutic 2.5 1.3 0.9 Pool Initial Additional 15 15 minutes minutes (round to nearest 15 minutes) (3) PATIENT EDUCATIONAL ACTIVITIES Patient educational activities are used to 1.4 1.3 instruct the patient or his attendant, family or their substitute in maintaining and improving the patient's condition. (4) COMBINATION OF EVALUATION, THERAPEUTIC OR PATIENT EDUCATIONAL ACTIVITIES Multiple evaluation, therapeutic, patient educational activities performed during a patient visit will be reported as a combination. (i) Any number of modalities in combination 1.0 0.9 (ii) Any number of evaluation, therapeutic, or 1.4 1.3 patient educational activities in combination (iii) Hydrotherapy in combination with other activities: Extremity or Body Whirlpool 1.4 1.3 Hubbard Tank or Therapeutic Pool 2.5 1.8 (5) HOME VISITS A home visit is provided to an individual patient in a setting other than the physical therapist's office or work facility. The standard unit of measure for home visits includes the number of relative value units for the evaluation, therapeutic, or patient educational activity and for travel time. (i) Evaluation, Therapeutic, or Educational 1.4 1.3 Activities (ii) Travel Time Travel time for home visits 1.3 1.3 is the actual time spent by physical therapy personnel going to and from the home. Travel time for multiple home visits during a single trip is calculated by dividing the total number of relative value units for travel time by the number of patients treated during that trip. (6) GROUP ACTIVITIES A group activity is the occasion for service 1.3 1.3 during which two or more patients simultaneously receive a therapeutic, evaluation, or patient educational activity. Group activities will be reported by counting the number of RVU's for one patient participating in the group activity session, and adding 0.1 RVU per session for each patient participating in the group activity.

(7) Notes

(i) For further explanation of how to use the relative value units see the accompanying Schedule of Unit Values and Examples of Relative Value Unit Computations for Combination Activities.

(ii) When multiple personnel are used during an entire activity period, additional 1.3 RVU's are recorded for each person for each 15-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 rounded to the nearest one-tenth (e.g., 0.62 = 0.6, 0.68 = 0.7).

(c) SCHEDULE OF UNIT VALUES UNIT VALUE TOTAL VALUES Description Initial Additional 30 45 60 15 min. 15 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 (iii) Hydrotherapy Extremity or Body Whirlpool Continuous attendance of personnel required 1.4 1.3 2.7 4.0 5.3 not required 1.4 0.9 2.3 3.2 4.1 Hubbard Tank or Therapeutic Pool Continuous attendance of 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 Educational 1.4 1.3 2.7 4.0 5.3 Activities (4) Combination of Evaluation, Therapeutic, or Patient Educational Activities (i) Any Number of Modalities 1.0 0.9 1.9 2.8 3.7 in Combination (ii) Any Number of Evaluation, 1.4 1.3 2.7 4.0 5.3 Therapeutic, or Patient Educational Activities in Combination (iii) Hydrotherapy in Combination with Other Activities Extremity or Body Whirlpool 1.4 1.3 2.7 4.0 5.3 Hubbard Tank or Therapeutic 2.5 1.3 3.8 5.1 6.4 Pool (5) Home Visits (i) Evaluation, Therapeutic, 1.4 1.3 2.7 4.0 5.3 or Patient Educational Activities (ii) Travel Time 1.3 1.3 2.6 3.9 5.2 (6) Group Activities (total 1.3 1.3 2.6 3.9 5.2 RVU's plus 0.1 per session for each patient)

Note:Activities that exceed 60 minutes are recorded by adding the appropriate values from the "additional 15 minutes" column.

(d) EXAMPLES OF RELATIVE VALUE UNIT COMPUTATIONS FOR COMBINATION ACTIVITIES Description Calculations RVU's (1) MODALITIES A patient is in the department for 60 minutes. The 1.0 + 0.9 = 1.9 patient waits 30 minutes before receiving 30 minutes of hot packs and cervical traction to the neck. Description Calculations RVU's (2) PROCEDURES Therapeutic exercise to the right leg and gait training 1.4 + 1.3 + 1.3 4.0 for 45 minutes. = (3) EVALUATION AND MODALITIES/ PROCEDURE Evaluation, hot pack, ultrasound, and massage to the 1.4 + 1.3 + 1.3 6.6 left shoulder for 75 minutes. + 1.3 + 1.3 = (4) HYDROTHERAPY (i) Extremity whirlpool, not requiring continuous 1.4 + 0.9 = 2.3 attendance of physical therapy personnel, 30 minutes. (ii) Therapeutic pool, requiring continuous attendance 1.4 + 1.3 + 1.3 4.0 of physical therapy personnel, 45 minutes. = (5) HYDROTHERAPY COMBINATIONS (i) Extremity whirlpool massage and exercise to the 1.4 + 1.3 + 1.3 5.3 left arm for 60 minutes. + 1.3 = (ii) Body whirlpool and exercise to both legs and back 1.4 + 1.3 + 1.3 5.3 for 60 minutes. 1.3 = (iii) Hubbard tank and burn debridement to upper torso 2.5 + 1.3 + 1.3 6.4 for 60 minutes with one staff member required; + 1.3 = with two staff members required. (2.5 + 1.3 + 11.6 1.3 + 1.3) + (1.3 +1.3 + 1.3 + 1.3) = (6) HOME VISIT (i) A visit is made to a patient's home and 25 minutes of diathermy is provided. A visit is then made to another patient's home and 35 minutes of gait training is provided. Travel time to and from the hospital as well as between the two homes is 45 minutes. (ii) The RVU's for travel time per home visit are the 1.3 + 1.3 + 1.3 2.0 total number of RVU's for travel time divided by the = 3.9 3.9 - total number of home visits. 2.0 =1.95 or 2.0 (iii) First visit: Diathermy treatment for 25 minutes. 1.4 + 1.3 = 2.7 Total RVU's for first home visit. 2.0 + 2.7 = 4.7 (iv) Second visit: Gait training for 35 minutes. 1.4 + 1.3 = 2.7 Total RVU's for second home visit 2.0 + 2.7 = 4.7 (7) GROUP ACTIVITIES (i) Ten patients received exercise instruction and patient education. The activity session was 35 minutes in Duration. (ii) One staff member required. (1.3 + 1.3) + 3.6 (0.1 x 10) = (Average RVU's per patient =0.36 or 0.4 (iii) Two staff members required. (1.3 + 1.3) + 6.2 (1.3 + 1.3) + (10 x 0.1) = (Average RVU's per patient = 0.62 or 0.6)

Notes

N.Y. Comp. Codes R. & Regs. Tit. 10 § 447.4