Having an adequate billing system in place is essential in having a successful physical therapy practice. In 2018, changes to the medical coding system are continuous and with the upcoming evolution towards ICD-10, many physical therapy practices need to have the knowledge and education to understand and implement these new requirements in order to get paid for services. When your practice makes mistakes in coding, it can result in delayed or denied claims. Not only that, but it takes time, money and education to adequately maintain a billing department in-house to help optimize your physical therapy practice’s profits.
In this post, we’ll discuss some of the basic terminology your practice should be familiar with when billing and the most popular CPT codes being used to successfully bill for services today.
Physical Therapy Billing terminology
Let’s outline some of the common billing terminology. This is useful in order to understand how to effectively use physical therapy CPT codes as well as communicate with your biller, when necessary.
Untimed codes: When an untimed code is used, there is a predetermined fee for the session, regardless of the type of treatment, modality or the number of areas of the body being treated. This type of code can only be used once for an individual treatment and must not be included as part of billing calculations for timed treatment. This is separate from timed treatment. For example, if you plan to bill for a 60-minute session and you will use an untimed code for 15 minutes of the session. You would only bill for the remaining 45 minutes using a different code.
Timed codes: Timed codes are exactly what they sound like, these are billing codes that are used to bill for the actual time a practitioner spends with a patient as well as time for skilled interventions. These codes include time for pre-treatment, actual treatment and post-treatment. For example, if you plan to use this code for a 30-minute treatment session, you could bill for the entire session under this code.
Pre-treatment time: Assessment and case management are a necessary part of some physical therapy sessions. Physical therapists can bill for this time to assess patient progress, evaluate for injury or muscle deficits or analyzing the what approach will be taken during a treatment session under the purview of pre-treatment. Includes assessment and management, assessing patient progress, inspection of the tissue or body part, analyzing results of the previous treatment, asking questions, and using clinical judgment to establish the day’s treatment. This can all be billed as contact time from the physical therapist or aide. With this code, if you spend 20 minutes performing manual muscle testing using a handheld dynamometer, this would be billed under pre-treatment time.
Intra-treatment time: This code refers to any time spent providing an intervention.
Post-treatment time: Some time is spent each session analyzing a patient’s response to either an intervention, treatment or giving education or home exercise program. Post-treatment time can also include time spent documenting in the patient’s chart and/or consulting with other healthcare professionals about the patient’s care. The only caveat to this rule is that the patient must be present when these events occur in order to use this code. For example, if you spend 10 minutes explaining how to do exercises for the patient’s home exercise program, this could be billed as post-treatment time.
The 8-Minute Rule: The 8-minute rule is an important one to understand, because according to American Medical Association (AMA) guidelines, leftover minutes that fall into multiple categories with less than 8 minutes per category cannot be billed for. For example, if you spend 6 minutes providing manual therapy and 5 minutes providing ultrasound therapy. The codes must be totaled and billed for the treatment with the greater treatment time. This also works according to Medicare guidelines (8-Minute Rule), where you can combine this extra time (11 minutes total) into one additional unit of manual therapy since the sum of your remainders was more than 8 minutes (you bill for the service that you provided more of, hence, manual therapy in this case)
Medicare 8-Minute Rule:
1 unit of treatment time = 8-22 minutes
2 units of treatment time = 23-37 minutes
3 units of treatment time = 38-52 minutes
4 units of treatment time = 53-67 minutes
5 units of treatment time = 68-82 minutes
6 units of treatment time = > 83 minutes
The Most Common CPT Codes in Physical Therapy
The most common CPT codes billed by physical therapists fall into two categories:
- Therapeutic exercise (CPT 97110)
- Manual therapy (CPT 97140).
Below is a comprehensive list of CPT codes to know as well as their descriptions:
- 97001 Physical Therapy Evaluation
- 97002 Physical Therapy Re-evaluation
- 97010 Hot or Cold Packs: Application of a modality to one or more areas; hot or cold packs
- 97012 Mechanical Traction: Application of a modality to one or more areas; traction, mechanical
- 97014 Electrical Stimulation (unattended): Application of a modality to one or more areas; electrical stimulation (unattended)
- 97016 Vasopneumatic Device: Application of a modality to one or more areas; vasopneumatic devices
- 97018 Paraffin bath: Application of a modality to one or more areas; paraffin bath
- 97022 Whirlpool: Application of a modality to one or more areas; whirlpool
- 97024 Diathermy: Application of a modality to one or more areas; diathermy (eg, microwave)
- 97026 Infrared: Application of a modality to one or more areas; infrared
- 97028 Ultraviolet: Application of a modality to one or more areas; ultraviolet
- 97032 Electrical Stimulation (manual): Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes
- 97033 Iontophoresis: Application of a modality to one or more areas; iontophoresis, each 15 minutes
- 97034 Contrast Bath: Application of a modality to one or more areas; contrast baths, each 15 minutes
- 97035 Ultrasound: Application of a modality to one or more areas; ultrasound, each 15 minutes
- 97036 Hubbard Tank: Application of a modality to one or more areas; Hubbard tank, each 15 minutes
- 97110 Therapeutic Exercise: Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility. (Generally describes a service aimed at improving a single parameter, such as strength, ROM, etc.)
- 97112 Neuromuscular Re-education: Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities
- 97113 Aquatic Therapy: Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercise
- 97116 Gait Training: Skilled improvement of gait, includes stair climbing
- 97124 Massage Therapeutic: procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
- 97140 Manual Therapy Techniques: Skilled manual therapy techniques (mobilization, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes. ( PROM is NOT manual therapy)
- 97530 Therapeutic Activity: Use of dynamic activities to improve functional performance. Describes the activities that use multiple parameters (strength, ROM, balance, etc) together and focus and achieving functional activity.
- 97535 Self Care / Home Management: Self care/home management training (ADL and compensatory training, meal preparation, safety procedures and instructions in the use of assistive technology devices/adaptive equipment)
- 97542 Wheelchair Management: Wheelchair Management (eg, assessment, fitting, training), each 15 minutes
- 97760 Orthotic Management: Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes
- 97761 Prosthetic Management: Prosthetic training, upper and/or lower extremity(s), each 15 minutes
- 97762 Orthotic/Prosthetic Checkout: Checkout for orthotic/prosthetic use, established patient, each 15 minutes
- 97150 Group Therapeutic: procedure(s), group (2 or more individuals)
- 29530 Knee Strapping
- 29540 Ankle Strapping
- 29240 Shoulder Strapping