Coding and Billing Physical Therapy:
Billing and Coding for Physical Therapy services may be tricky and might
affect your reimbursement. These services are only covered if medically
necessary. Coverage based on the diagnosis and the patient’s condition
should also be determined. The patient’s diagnosis may be different of
that from the referring physician. The plan of care and the duration of
the care must also be carefully determined.
Physical Therapy under Medicare are not covered not unless the
referring physician that the services is medically necessary for the
beneficiary’s condition. The referring physician must establish a written
treatment plan for physical therapy services. This must be reviewed
every 30 days and must be re-certified should the patient need to
continue Physical Therapy.
Per CPT 2007 Book:
CPT Code 97001 Physical Therapy Evaluation
CPT Code 97002 Physical Therapy Re-Evaluation
Therapeutic Procedures:
CPT Code 97110 Therapeutic procedure, one or more areas, each
15 minutes; therapeutic exercises to develop strength and endurance,
range of motion and flexibility
CPT Code 97112 Neuromascular reeducation of movement,
balance, coordination, kinesthetic sense, posture, and/or proprioception
for sitting and or standing activities
CPT Code 97116 Gait Training (includes stair climbing)
CPT Code 97124 Massage, including effleurage, petrissage and/or
tapotement (stroking, compression and percussion). (For Myfascial
release, use 97140)
CPT Code 97140 Manual Therapy Techniques (eg.
mobilization/manipulation, manual lymphatic drainage, manual traction),
one or more regions, each 15 minutes
CPT Code 97150 Therapeutic procedure(s), group (2 or more
individuals). Report 97150 for each member of the group.
Common Mistakes in Reporting and Billing Physical Therapy Services:
1. Billing for example, the therapeutic exercise CPT Code 97110 for
3 units, 97110 code is being entered thrice on each line on the claim
form
2. Improper reporting of number of units for timed codes/services
3. No referring physician information on the claim
4. Poor Medical Documentation
Billing Timed Services such as 97110, 97140 and 97112:
Do not report any service done less than 8 minutes!
8 minutes to 22 minutes is billed as 1 unit
23 minutes to 37 minutes is billed for 2 units
38 minutes to 52 minutes is billed for 3 units
Trick:
If two modalities are used on the same treatment day:
eg.:
97110 39 minutes
97112 23 minutes
total treatment time: 62 minutes (4 units of PT services)
Report: 97110 for 3 units; 97112 for 1 unit. Assign more units to the
PT service that took more time.
All timed services must be documented on the medical record of the
patient.
Modifier Used for Physical Therapy Services:
GP Physical Therapy service rendered by a Physical Therapist
59 Distinct Procedural Service
*** use modifier -59 for second and subsequent modality,
multiple/different sites
Example:
97112 for Neck>> 97112 GP >> 723.1
97112 for Back >> 97112 GP 59 >>724.2
Look at the Outpatient Physical Therapy Cap for 2007 slides (you will
need a PowerPoint Viewer to view the slides. (downloaded from CMS
MedLearn)
Documentation in the patient’s medical record should include proper
evaluation leading to the diagnosis of the trigger points, specific
identification of the affected muscle(s). It must also be properly
documented the reason why injections are the chosen as a treatment
option.
**** For more references: Consult your CPT code books. The National
Correct Coding Initiative (NCCI) and third pary payer payment policies
and guidelines
*** another helpful article from Ms. Pinky
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