Dubin Orthopaedic Center, P.S.C v. Commonwealth, State Board of Physical Therapy

294 S.W.3d 421, 2009 Ky. LEXIS 55, 2009 WL 1107793
CourtKentucky Supreme Court
DecidedApril 23, 2009
Docket2007-SC-000756-DG
StatusPublished

This text of 294 S.W.3d 421 (Dubin Orthopaedic Center, P.S.C v. Commonwealth, State Board of Physical Therapy) is published on Counsel Stack Legal Research, covering Kentucky Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dubin Orthopaedic Center, P.S.C v. Commonwealth, State Board of Physical Therapy, 294 S.W.3d 421, 2009 Ky. LEXIS 55, 2009 WL 1107793 (Ky. 2009).

Opinion

*422 Opinion of the Court by

Justice ABRAMSON.

Kentucky Revised Statute 327.020(3) makes it unlawful “for any person, or for any business entity ... to bill for physical therapy unless such physical therapy is provided by or under the supervision of a physical therapist licensed and practicing in accordance with this chapter.” The Court of Appeals held that under this statute the Dubin Orthopaedic Center, PSC, and its sole shareholder, Ronald S. Dubin, M.D., a duly licensed orthopedic surgeon (collectively “Dubin”), were precluded from using certain American Medical Association billing codes for “physical therapy evaluation” and “physical therapy reevaluation” (Current Procedural Terminology codes 97001 and 97002). We granted Dubin’s motion for discretionary review to consider its right to use the codes and now reverse.

RELEVANT FACTS

The present controversy arose in November 2003, when the State Board of Physical Therapy (the Board), the agency authorized to license physical therapists and to regulate and oversee the practice of physical therapy in Kentucky pursuant to KRS Chapter 327, received a complaint that Dubin’s office in Corbin, Kentucky was offering “physical therapy” services, that those services were being provided by an unlicensed athletic trainer, and that Dubin was billing for the services using CPT codes 97001 and 97002. Investigating this complaint, as it was authorized to do under KRS 327.040(2) and (4), the Board subpoenaed certain patient treatment and billing records. When Dubin refused to surrender the records, the Board sought an order enforcing its subpoena in the Franklin Circuit Court. KRS 327.040(4). While the matter was pending before the circuit court, Dubin stipulated that it had used and intended to continue using CPT codes 97001 and 97002, whereupon, apparently, the Board relinquished its subpoena and moved instead to enjoin Dubin’s use of the two codes.

CPT stands for “Current Procedural Terminology,” and the CPT code is a work of clinical nomenclature published annually since 1966 by the American Medical Association. The CPT is, in essence, an evolving list of AMA recognized services and procedures (there are codes, however, for unlisted services and procedures) together with five-digit numerical codes for each. As explained in the forward of the 2006 edition, the purpose of the CPT’s descriptive terms and identifying codes “is to provide a uniform language that will accurately describe medical, surgical, and diagnostic services and will thereby provide an effective means for reliable nationwide communication among physicians, patients, and third parties.” The United States District Court for the Northern District of Georgia has further noted that

CPT has been adopted by both public and private health insurance programs (generally, “payors”) as the method by which physicians report the services and procedures they provide. CPT is not a reimbursement system, however, and does not constrain a payor’s decision to cover or not to cover a particular procedure. Each payor makes its own decisions regarding which services and procedures it will pay for and how much it will pay for each.

Neotonus, Inc. v. American Medical Association, 554 F.Supp.2d 1368, 1370 (N.D.Ga.2007). The United States Department of Health and Human Services has adopted the CPT as one of its standard medical data code sets. 45 C.F.R. § 162.1002. The CPT listings are organized under six broad headings and numerous subheadings, but *423 according to the introduction to the 2006 edition,

[i]t is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care provider.

Providers are instructed, rather, to “[s]elect the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided.” Id.

Noting that Dr. Dubin was licensed to provide services accurately described as “physical therapy evaluation” and “physical therapy reevaluation,” the trial court ruled that Dubin’s use of CPT codes 97001 and 97002 was a matter best left to Dubin and its third-party payors, and that use of the codes did not run afoul of KRS 327.020(3), which, according to the trial court, is addressed primarily to preventing unlicensed individuals from holding themselves out to the public as licensed physical therapists, a concern not implicated, the trial court concluded, by these facts. Accordingly, the trial court denied the Board’s request for injunctive relief.

By an Opinion rendered September 21, 2007, the Court of Appeals reversed. In its view, although Dr. Dubin’s medical license authorized him to provide services “that are the same or similar to the services performed by a licensed physical therapist,” the statutory restriction on the use of the phrase “physical therapy” applied to Dubin no less than to anyone else and precluded Dubin’s use of the two CPT descriptions employing that phrase and their numerical codes. According to the Court, notwithstanding the AMA’s injunction that health care providers use the most accurate code possible and their potential obligation to do so under federal law, KRS 327.020 required Dubin to choose some code other than 97001 or 97002 when describing and claiming payment for physical therapy services. Dubin contends, and we agree, that the Court of Appeals misconstrued KRS 327.020.

ANALYSIS

At issue, as noted above, is section (3) of KRS 327.020, 1 which provides:

(3) It shall be unlawful for any person, or for any business entity, its employees, agents or representatives to use in connection with his or its name or business activity the words “physical therapy,” “physical therapist,” “physiotherapy,” “physiotherapist,” “registered physical therapist,” the letters “P.T.,” “L.P.T.,” or any other words, letters, abbreviations or insignia indicating or implying directly or indirectly that physical therapy is provided or supplied or to bill for physical therapy unless such physical therapy is provided by or under the supervision of a physical therapist licensed and practicing in accordance with this chapter.

KRS 327.020(3) (1984).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

King Drugs, Inc. v. Commonwealth
250 S.W.3d 643 (Kentucky Supreme Court, 2008)
Neotonus, Inc. v. AMERICAN MEDICAL ASS'N
554 F. Supp. 2d 1368 (N.D. Georgia, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
294 S.W.3d 421, 2009 Ky. LEXIS 55, 2009 WL 1107793, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dubin-orthopaedic-center-psc-v-commonwealth-state-board-of-physical-ky-2009.