SOAP 2.0 | CO/CQ Modifiers Workflow
  • 26 Mar 2024
  • 3 Minutes to read
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SOAP 2.0 | CO/CQ Modifiers Workflow

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Article Summary

Overview

Since January 1, 2020, CMS requires modifiers to be applied to services provided by a PTA or OTA for patients with Medicare as the primary or secondary insurance. These modifiers, CQ and CO respectively, should be applied to any service where 10% or more was provided by the assistant.

  • CQ modifier: Services furnished in whole or in part by a PTA.
  • CO modifier: Services furnished in whole or in part by a OTA.
Modifier Availability

The availability of these modifiers is enabled for Medicare-type insurances by default. For all other insurances, this feature must be enabled manually by selecting Apply Therapist Assistant Modifiers (CO/CQ) in the payer’s Insurance Settings. Discover more about Insurance Settings in the WebPT EMR.

CMS Assistant Modifiers Compliance

To comply with CMS 2022 rules around Assistant Modifiers, the WebPT EMR can 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.

Click the arrow or colorblock below to discover more.



Scenario 1: Assistant Forwarding a Note

Scenario 1: Assistant Forwarding a Note

  1. A PTA (or OTA) begins a note in the WebPT EMR and enters charges for the services provided.
    EMR_2.0_Documentation_Charge Summary_CQ Modifier1

    Modifier Visibility

    The appropriate modifier based on the user type automatically populates in the Modifier section and cannot be removed by the assistant.

  2. The PTA or OTA will forward the note to a supervising therapist by using the (...) menu button to select Forward.
    EMR_2.0_Documentation_Forward Note

  3. Select the supervising therapist from the drop-down menu, then click Apply.
    EMR_2.0_Documentation_Forward Note_Choose Therapist

  4. The supervising therapist will open the note by navigating to the Incomplete Cosign Documents in the At a Glance alerts section of the Dashboard.
    EMR_Dashboard At a Glance_Incomplete Cosign Docs

  5. From the Incomplete Cosign Documents table, select the note needing to be co-signed.
    EMR_Incomplete Cosign Docs List

  6. The supervising therapist will see the CO or CQ modifier listed next to each code added by the assistant. The therapist has a few options here:
    a. If any of the services were done in full by a PT or OT (greater than 90% of the service), you can click on the Modifier dropdown menu and uncheck the modifier to remove it from that CPT® Code.
    EMR_2.0_Documentation_Charge Summary_CQ Modifier_Checkbox

    b. You can also choose to split out the time spent on a CPT® Code by clicking the split icon and documenting the time that was spent by the assistant and the therapist. When a code is split there will be two charge lines: one with the assistant modifier applied, and one without. Services where 10% or more of the service was provided by an assistant should be documented in the line with the modifier applied.
    EMR_2.0_Documentation_Charge Summary_Split CPT Codes

:::(Info)(Addended Notes)
If a charge is added in an addendum to this note by a PT or OT, the modifier will not be automatically applied. The CO/CQ modifiers will be available for selection as needed.
:::



Scenario 2: Assistant Finalizing a Note

Scenario 2: Assistant Finalizing a Note

If you have enabled the ability for an assistant to finalize notes, the CQ or CO modifier will be automatically added to all CPT codes.

EMR_2.0_Documentation_Charge Summary_Split CPT Codes_Assistant Finalization

Discover more about how assistants can finalize notes.



Do I need to use the CQ and CO modifiers if I bill Medicare Part A?

If you bill Medicare Part A for your services (e.g., rehab agencies, CORFs), you will need to use the CQ/CO modifiers for any services furnished by a PTA or OTA. The requirement applies to payments for physical and occupational therapy in private practice, outpatient hospitals, rehab agencies, skilled nursing facilities, home health agencies, and comprehensive outpatient rehab facilities.

 
Billing Part A for outpatient therapy services does not exempt the practice from this requirement as payment is still made on the Part B physician fee schedule.




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