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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