Applying Assistant Modifier minutes for each CPT code (SOAP 1.0)
IN THIS ARTICLE
To comply with CMS 2022 rules around Assistant Modifiers, the WebPT EMR can now identify both therapist and assistant contributions for each CPT code. The WebPT EMR will then use the minutes you provide to auto-calculate which units should have the Assistant Modifier, and which should not. This CO/CQ Modifier feature will not be present for dates of service prior to January 1st, 2022.
Documenting CO/CQ without Note Forwarding
Please note that if your clinic operates in a model that uses Assistants and Therapists to co-treat on the same date of service, but you do not use a workflow that has the note forwarded from the assistant, you lose the ability to tie the assistant’s efforts to the appropriate unit.
For instance, if the therapist documents a visit and indicates that an assistant contributed minutes to a CPT code, the Documented Units report in analytics WILL NOT be able to tie the treatment back to a specific assistant. If you use this analytics report to track assistant productivity, the recommended workflow is to have an assistant start a note and forward it to the therapist for finalization. This workflow is the only accurate method to tie an assistant to the units for productivity when a co-treatment is performed.
In SOAP 1.0 you can record the therapist versus assistant minutes for each code as seen in the example below. In this example, the Direct Timed Codes for Aquatic Exercise would be under-billed based on the total direct minutes performed by the therapist and assistant.
Applying Assistant Modifiers
The ability to use and enter Therapist versus Assistant minutes for each CPT code is based on how the Company Payer Rules and Insurance (payer) settings are applied in the WebPT EMR. How these settings are applied will determine if you need to record split entries for therapist versus assistants, regardless of whether or not the payer requires the use of CQ/CO modifiers, or if you follow the conflict rule for the primary payer or the most stringent payer.
The scenarios below will help you understand when the ability to record therapist/assistant minutes will be visible.
- Scenario 1: When the patient’s primary payer Insurance settings Apply Therapist Assistant Modifiers (CO/CQ) is enabled and the Company Setting for Payer Rules is designated as Primary Payer, the new changes will be there.
- Scenario 2: When the patient’s primary payer Insurance settings Apply Therapist Assistant Modifiers (CO/CQ) is NOT enabled, and the patient’s secondary payer Insurance settings Apply Therapist Assistant (CO/CQ) is enabled, but Company Setting for Payer Rules is designated as Primary Payer the changes will NOT be present.
- Scenario 3: When the patient’s primary payer Insurance settings Apply Therapist Assistant Modifiers (CO/CQ) is NOT enabled, and the patient’s secondary payer Insurance settings Apply Therapist Assistant Modifiers (CO/CQ) is enabled, and the Company Setting for Payer Roles is designated as Most Stringent, then the changes WILL be present.
Once the Payer rules are applied accordingly in the Insurance and Company Settings, you can record how many minutes each provider type completed on a per-CPT code basis. The WebPT EMR will then determine when and where to apply the Assistant Modifiers for you. See below for how the CO/CQ modifiers are applied.
How the EMR uses minutes to apply Assistant Modifiers
Untimed CPT Codes
- Untimed CPT codes still use the de minimis standard for the application of CO/CQ. So, if the assistant performed 10% or more of the total minutes for an untimed CPT code, then the Assistant Modifier will be applied.
Timed CPT Codes
- For timed codes, the midpoint rule is used for the last unit of a CPT code. This means that if the therapist performed 8 or more minutes of a CPT code, then they get credit for that unit and the assistant modifier will not be applied.
- Any timed CPT codes performed in whole 15-minute increments by an assistant will have the modifier applied.
- In situations where both the therapist and the assistant performed less than 8 minutes of treatment for a given CPT code on the final unit, then the de minimis logic applies again.
- Situations where both the therapist and assistant performed between 8-14 minutes of the last 2 units of a CPT code are a special case. In these scenarios, one unit will have the assistant modifier and the other will not.
Preview and Finalizing the Note
- Once you are ready to preview or finalize the note, the EMR will do the per-CPT code calculations to automatically apply the Assistant Modifier.
- Looking at the PDF of the previewed or finalized note will show you how your billed CPT codes are split based on the units with or without the CO/CQ modifier.
- The information reflected in the PDF of the finalized charge summary will be sent to any billing integration partners.
To Change Your Company Payer Rules
You must have Company Admin permissions to change your Company Settings.
- Click the Company drop-down in the upper right, then click Company Settings.
- Locate Payer Rules under Additional Modifiers and choose the Primary Payer or Most stringent (8-minute Rule) radio button.
- Click Save Settings.
Insurance (Payer) Settings
For visibility and use of this feature, you must review and update your Insurance (Payer) Settings as follows. Users must have Insurance Admin permissions to change Insurance Settings.
Add Apply Therapist Assistant Modifier Insurance (Payer) Settings
To use this feature check Apply Therapist Assistant Modifiers (CO/CQ) Assistant Modifiers in the Insurance (Payer) Settings.
To see the Assistant Modifier minutes functionality check Require users to record minutes for CPT codes.
Click here to find out how to Add or Edit Insurance (Payer) Settings.