Therapy Lymphedema and Maintenance Service Codes

Purpose:  

• Lymphedema care is a clinical specialty requiring a higher level of education and technical skill versus routine therapy services therefore needs to be designated as such.
• Maintenance therapy is a unique service different from that of a traditional restorative therapy that has an elevated level of scrutiny by regulatory agencies due to the nature of the service. As a result, there is no easy way to identify these visits for chart audits to ensure compliance.  
• HCHB standard service codes do not accommodate these unique patient visits therefore it is necessary to have specific codes so there is an accurate method to account for these visits operationally. 
• New service codes have been developed address these unique therapy services and are identified with the following moniker at the end of the service code: 
  • Lymphedema has “LY” at the end of the service code.
  • Maintenance has “MT” at the end of the service code.
• The service codes and note structures are the same as normal visits with the identifier indicating the type of visit associated with the appropriate visit weight. 

Process:

Lymphedema

1. There are no changes in processes for scheduling visits within Point Care post evaluation.
2. A therapist will select the calendar date(s) and select the appropriate service code for Lymphedema noted with “LY” at the end. I.e., PT11LY
3. Codes exist for professional (PT and OT) and paraprofessional (PTA and COTA) clinicians. 
4. Below are the specific codes for lymphedema:

Note: OASIS items (00, 15, 02, or 18) are unchanged and will be assigned as normal. There are no special unique Lymphedema service codes for these tasks. 

Maintenance

1. There are no changes in processes for scheduling visits within Point Care post evaluation.
2. A therapist will select the calendar date(s) and select the appropriate service code for Lymphedema noted with “MT” at the end. I.e., PT11MT
3. Codes exist for professional (PT and OT) and paraprofessional (PTA and COTA) clinicians. 
4. Below are the specific service codes:

Note: Evaluations, re-evaluations, discipline discharges and all OASIS (00, 15, 02 or 18) are unchanged and there is no “MT” identifier as these tasks will be scheduled as normal. 

1. Clinicians will continue to select the Maintenance claim code at the end of the subsequent visit to support billing.