13TH AND 19TH VISIT – DECODING THE REASSESSMENT

13th and 19th Therapy Visit

The big difference between tracking the number of therapy visits and monitoring the 30 day issue is what is being counted. “Minimally” every 30 days looks at the calendar while the 13th and 19th visits require literal sequential counting of all therapy visits combined. The counting of visits is specific to each certification period and restarts with each individual 60 day episode. It helps to think about this in terms of billing as the final claim will contain all the therapy visits provided in that episode and the payment is impacted by the total number of physical therapy, occupational therapy, and speech language pathology visits.

The guidance regarding counting varies depending on the number of therapy disciplines that are involved in the care. The table that follows has been created to try to sort of some of the confusion.

Key Issues to Consider:

  • Rural Exception. This is driven by the CBSA code the patient resides in. It is very important that therapy staff understand that the designation is applied in this way and not on a personal interpretation. It impacts single therapy cases in relation to allowing a window in which to complete the reassessment. It is an acknowledgement that providers in rural areas may face staffing challenges that could make it an additional challenge to meet the requirements of a literal visit target. Keep in mind that these ranges are below 14 and 20 and indicate that proactive planning is a key element of compliance.
  • “Closest to exception…” In multiple therapy cases, the expectation is that the reassessments are completed within the ranges of 11 – 13 and again at 17 – 19 total visits. In order to alleviate some concerns regarding the challenges of scheduling, an exception process is in place. For therapies involved in the case that have a visit scheduled within those ranges, that is when the reassessment has to be completed. If there is no visit naturally falling in the range for that therapy, the expectation is that the reassessment be completed on the visit “closest to” the range. Specifically, there is nothing requiring that one of the therapies does a reassessment on the literal 13th or 19th visit.
  • Resetting 30 days. The completion of a reassessment at any visit resets the expectation of every 30 days. It is important not to forget this in cases that continue therapy past the 19th visit as it is possible another reassessment would be required within the certification period.