What is Physical Therapy Billing?
Physical therapy billing is where physical therapists receive reimbursements for services similar to other medical billing. The billing system matches services provided with standards that describe the treatment received. This allows insurance companies and other payers to decide how much.
As physical therapy is an important part of healthcare (helping people recover from injuries, illnesses and surgeries by improving their mobility, strength and adaptation) and many patients use insurance benefits to pay for physical therapy services therefore physical therapists need to have a general understanding of their services cost, billing codes, and reimbursement. Physical Therapy billing is dedicated to provide professional services to physical, occupational and speech therapists, physicians and groups throughout the United States.
Coding for Physical Therapy Billing
Physical therapy billing at multiple levels can take a long time to complete, especially when done manually. But there are many ways to improve this process to increase time and revenue. Physical therapy billing involves the use of CPT and ICD-10 codes and modifiers to describe the services provided and conditions treated by physical therapists. These numbers are important for handling claims and receiving reimbursements from insurance companies. To ensure effective billing processes, physical therapists and billing staff need to be well versed in these rules and other billing methods.
The Current Procedural Terminology (CPT)
Current Procedure Codes (CPT) codes are used to identify medical procedures and services provided by physicians. The following CPT codes are commonly used for physical therapy:
- 97032: Manual electrical stimulation.
- 97035: Ultrasound
- 97110 :Therapeutic services/exercise.
- 97116: Gait training.
- 97140: Manual therapy.
- 97112: Neuromuscular re-education.
- 97113: Neurological re-education.
- 97530: Therapeutic activities.
- 97033: Iontophoresis.
- 97761: Prosthetic training.
- 97750: Self care/Home management.
There are two types of CPT codes billed in physical therapy:
Time Based Physical Therapy codes:
Time-based numbers are billed when a physical therapist has direct one-on-one contact with the patient. Physiotherapists can receive a fee from the physical therapy unit for every 15 minutes they spend with the patient.
The following is a list of time-based CPT codes, which can be billed as billing units, physical therapy:
- 97110: Therapeutic exercise.
- 97530: Therapeutic activities.
- 97140: Manual therapy.
- 97112: Neuromuscular re-education.
- 97116: Gait training.
- 97035: Ultrasound.
- 97033: Iontophoresis.
- 97032: Electrical stimulation (manual).
Service Based Physical Therapy codes:
Services covered by CPT rules include procedures and services where the physician does not have regular, one-on-one contact with the patient. For standard services, the policy is always to charge per unit, regardless of how long the process takes.
The following is a list of service-based CPT codes:
- 97161: PT evaluation.
- 97164: PT re-evaluation.
- 97014/GO283: Electrical stimulation (unattended).
- 97010: Hot/cold packs.
The International Classification of Diseases (ICD) for Physical Therapy Billing
International Classification of Diseases, (ICD-10) codes are used to describe diagnoses and conditions. The following ICD-10 codes are commonly used for physical therapy:
- M25.50: Pain in the joint, not elsewhere classified.
- M54.5: Low back pain.
- M62.81: Muscle weakness (generalized).
- M75.52: Rotator cuff tears or ruptures.
- M79.2: Neuralgia and neuritis, unspecified.
- M87.0: Osteonecrosis due to drugs.
- M87.1: Osteonecrosis due to previous trauma.
- S83.511A: Sprain of anterior cruciate ligament of right knee, initial encounter.
Modifiers:
Physical therapists use modifiers to provide additional information about the services they offer. They commonly use the following adjustments in physical therapy billing:
- GP: Services provided by a physical therapist.
- GO: Services provided by an occupational therapist.
- KX: Services that exceed Medicare’s cap on therapy services.
- 59: Distinct procedural service, used to indicate a service that is separate and distinct from other services provided on the same day.
8 Minute rule in Physical Therapy
8 Minute rule for Physical Therapy is exception in time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare. Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15. You can bill for one more unit if there are eight or more minutes left over; you cannot bill an additional unit if there are seven or fewer minutes remaining.
A physical therapist should be expert on the 8-minute rule because it is an important part of treatment, billing, and payment for patients.
Conclusion
Effective billing and coding practices for physical therapy services are vital in ensuring the hassle free functioning of healthcare practice. Accurate procedure coding to thorough documentation and compliance to industry guidelines, the phases involved in this process are crucial to fair compensation for healthcare providers and best care for patients. The efforts between healthcare providers, billing specialists, and coding experts are essential in navigating through the complexities of the healthcare landscape.
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For more coding details for other practices and physical therapy refer to this link.