“Hey, you are the McKnight’s lady?”
“The one that writes about rehab.”
I am indeed.
Those lines, during the past few months of conference season I have heard often.
The questions also often come with a sense that my reality is somewhat different than others. That I somehow have special internal knowledge or a greater sense than others of what occurs in the industry.
Simply not true.
I started my career as an SLP. I have always enjoyed writing, and to that end much of what you see in Rehab Realities comes from rule making and publicly accessible information.
My real life comes with the same day-to-day annoyances we all face.
Take, for example, the day I returned home from Thanksgiving family visits to not one, not two, but three catastrophes.
A broken washer that refused to drain and essentially flooded the laundry room.
A broken dishwasher… it doesn’t get much worse for a family of seven.
And to top it all, a leak in the roof that proceeded to drain into two showers and down the living room wall.
Please get me out of here, I think to myself. Anywhere but here.
Do you sense that our patients may feel the same way on occasion?
They miss the warmth and comforts of their homes, they long to see and experience the sound of the ocean, return to special locations associated with childhood memories and so on …
Furthermore, there is growing research in virtual reality (VR) for treatment of pain, chronic conditions, mental health and others.
What if we, as rehab professionals, could use VR to support these experiences and report their benefit to payers?
In 2023, this exactly will become reality with a new VR Level III add-on CPT® code 0770T.
To begin, we need to understand the intent of Level III CPT® codes.
Category III codes are temporary CPT® codes representing new technology and have specific criteria.
The following criteria are used by the CPT/HCPAC Advisory Committee and the CPT® Editorial Panel for evaluating Category III code applications:
- The procedure or service is currently or recently performed in humans AND
At least one of the following additional criteria has been met:
- The application is supported by at least 1 CPT® or HCPAC Advisor representing practitioners who would use this procedure or service (or)
- The actual or potential clinical efficacy of the specific procedure or service is supported by peer-reviewed literature, which is available in English for examination by the CPT® Editorial Panel (or)
- There is:
- At least one Institutional Review Board-approved protocol of a study of the procedure or service being performed
- A description of a current and ongoing United States trial outlining the efficacy of the procedure or service or
- Other evidence of evolving clinical utilization
They are priced and covered at the discretion of individual payers. 0770T will be sunset in January 2028, unless it is converted to a permanent CPT® code or is renewed as a Category III code for another five years.
Next, let’s explore the intended use of 0770T.
Virtual reality technology may be integrated into multiple types of patient therapy as an adjunct to the base therapy. Code 0770T is an add-on code that represents the practice expense for the software used for the VR technology and may be reported for each session for which the VR technology is used.
VR technology is incorporated into the base therapy session and is used to enhance the training or teaching of a skill upon which the therapy is focused.
Code 0770T does not incur any additional reported therapist time beyond that already reported with the base therapy code: 0770T Virtual reality technology to assist therapy. (List separately in addition to code for primary procedure.)
The following CPT® codes can be used in conjunction with 0770T and should only be reported once per session.
Psychotherapy codes: Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development-90832, 90833, 90834, 90836, 90837, 90838, 90847, 90849, 90853
- 90832 Psychotherapy, 30 minutes with patient
- 90833 Psychotherapy, 30 minutes with patient when performed
- 90834 Psychotherapy, 45 minutes with patient
- 90836 Psychotherapy, 45 minutes with patient when performed
- 90837 Psychotherapy, 60 minutes with patient
- 90838 Psychotherapy, 60 minutes with patient when performed
- 90847 Family psychotherapy (conjoint psychotherapy)
- 90849 Multiple-family group psychotherapy
- 90853 Group psychotherapy (other than of a multiple-family group)
Health Behavior Assessment and Intervention codes: Health behavior assessment and intervention services are used to identify and address the psychological, behavioral, emotional, cognitive and interpersonal factors important to the assessment, treatment or management of physical health problems.
The patient’s primary diagnosis is physical in nature and the focus of the assessment and intervention is on factors complicating medical conditions and treatments. These codes describe assessments and interventions to improve the patient’s health and well-being utilizing psychological and/or psychosocial interventions designed to ameliorate specific disease-related problems — 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171.
- 96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
- 96159 each additional 15 minutes
- 96164 Health behavior intervention, group (2 or more patients),
- 96165 each additional 15 minutes (List separately in addition to code for primary service)
- 96167 Health behavior intervention, family (with the patient)
- 96168 each additional 15 minutes (List separately in addition to code for primary service)
- 96170 Health behavior intervention, family (without the patient)
- 96171 each additional 15 minutes (List separately in addition to code for primary service)
Adaptive behavior treatment codes which describe services that address specific treatment targets and goals based on results of previous assessments (see 97151, 97152, 0362T), and include ongoing assessment and adjustment of treatment protocols, targets and goals: 97153, 97154, 97155, 97158.
- 97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
- 97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more
- 97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes
- 97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified healthcare professional, face-to-face with multiple patients, each 15 minutes
Finally, in the series of codes are those traditionally used by rehab professionals including: 92507, 92508, 97110, 97112, 97129, 97150, 97530, 97533, 97535, 97537
- 92507 Treatment of speech, language, voice, communication,
- 92508 (above) group, 2 or more individuals
- 97129 Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
- 97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
- 97112 neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities
- 97150 Therapeutic procedure(s), group (two or more individuals)
- 97530 Therapeutic activities, direct (1-on-1) patient contact (use of dynamic activities to improve functional performance), each 15 minutes
- 97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes
- 97535 Self-care/home management training (eg, activities of daily living and compensatory training, meal preparation, safety procedures and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes
- 97537 Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes
Additionally, 0770T will be sunset January 2028, unless it is converted to a permanent CPT® code or is renewed as a Category III code for another five years. Providers should check with payers for use compliance. As with all new allowances, we must do our due diligence to promote coding accuracy to ensure further development and provision of care for those we serve.
VR may just be a new tool for us to facilitate patient success … how can you use it to take patients away and tap into new levels of reality?
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.