{"id":264,"date":"2021-11-16T03:21:17","date_gmt":"2021-11-16T03:21:17","guid":{"rendered":"https:\/\/atlanticrcm.com\/blog\/?p=264"},"modified":"2021-11-16T03:21:17","modified_gmt":"2021-11-16T03:21:17","slug":"your-go-to-guide-to-medical-coding-for-physical-therapy","status":"publish","type":"post","link":"https:\/\/atlanticrcm.com\/blog\/your-go-to-guide-to-medical-coding-for-physical-therapy\/","title":{"rendered":"Your Go-To Guide to Medical Coding for Physical Therapy"},"content":{"rendered":"<p>Rejected or delayed reimbursements, after spending hours to rehabilitate injured patients can be demeaning for physical therapy practices. Claim denials, rejections, and delays can hurt the continuity of the business for the healthcare providers.<\/p>\n<p>Insurance billing for physical therapy is complex. With rapid changes in the outpatient practice, it is now more important to understand the proper usage of the <a href=\"https:\/\/atlanticrcm.com\/blog\/everything-physical-therapists-need-to-know-about-cpt-99072\/\">current procedural terminology (CPT) codes<\/a>.<\/p>\n<p>CPT codes are managed and updated every year by the American Medical Association. Changes and updates for the year 2021 include:<\/p>\n<ul>\n<li>329 editorial changes<\/li>\n<li>206 new codes<\/li>\n<li>69 revised code descriptors, and<\/li>\n<li>54 deleted code.<\/li>\n<\/ul>\n<p>63% of the new codes involve new technology or services, implemented due to the <a href=\"https:\/\/atlanticrcm.com\/blog\/everything-physical-therapists-need-to-know-about-cpt-99072\/\">COVID-19 pandemic<\/a>. There are changes in nearly every section. Hence, correct coding is dependent on understanding the latest coding resources and the associated guidelines.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-265\" src=\"https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy.jpg\" alt=\"Medical Coding for Physical Therapy\" width=\"900\" height=\"600\" srcset=\"https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy.jpg 900w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy-300x200.jpg 300w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy-768x512.jpg 768w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy-219x146.jpg 219w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy-50x33.jpg 50w, https:\/\/atlanticrcm.com\/blog\/wp-content\/uploads\/2021\/11\/Medical-Coding-for-Physical-Therapy-113x75.jpg 113w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_69_1 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In this Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/atlanticrcm.com\/blog\/your-go-to-guide-to-medical-coding-for-physical-therapy\/#10_of_the_most_commonly_used_CPT_codes\" title=\"10 of the most commonly used CPT codes:\">10 of the most commonly used CPT codes:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/atlanticrcm.com\/blog\/your-go-to-guide-to-medical-coding-for-physical-therapy\/#Key_points_to_consider_while_billing_includes\" title=\"Key points to consider while billing includes:\">Key points to consider while billing includes:<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"10_of_the_most_commonly_used_CPT_codes\"><\/span><strong>10 of the most commonly used CPT codes:<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<table width=\"595\">\n<tbody>\n<tr>\n<td width=\"66\"><strong>CPT<\/strong><\/td>\n<td width=\"529\"><strong>Description<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97110<\/td>\n<td width=\"529\">Therapeutic Exercise<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97112<\/td>\n<td width=\"529\">Neuromuscular Re-Education<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97116<\/td>\n<td width=\"529\">Gait Training<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97140<\/td>\n<td width=\"529\">Manual Therapy<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97150<\/td>\n<td width=\"529\">Group Therapy<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97530<\/td>\n<td width=\"529\">Therapeutic Activities<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97535<\/td>\n<td width=\"529\">Self-Care\/ Home Management Training<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97750<\/td>\n<td width=\"529\">Physical Performance Test or Measurement<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97761<\/td>\n<td width=\"529\">Prosthetic Training<\/td>\n<\/tr>\n<tr>\n<td width=\"66\">97762<\/td>\n<td width=\"529\">Checkout Orthotic\/ Prosthetic Use<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span class=\"ez-toc-section\" id=\"Key_points_to_consider_while_billing_includes\"><\/span><strong>Key points to consider while billing includes:<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li><strong>Medicare: untimed and timed codes:\u00a0<\/strong>Untimed codes can be billed only once per session. The <a href=\"https:\/\/atlanticrcm.com\/blog\/2021-medicare-changes-for-physical-therapists-speech-language-therapists-and-occupational-therapists\/\">physical therapist<\/a> is paid a predetermined fee irrespective of the duration of the treatment. Reimbursements for timed codes are based on the total duration of the treatment, working one-on-one with the patient. They can be billed multiple times per session of 8 minutes each.<\/li>\n<li><strong>Modifier codes<\/strong>\u00a0are two-digit codes that add information or changes the description of a <a href=\"https:\/\/atlanticrcm.com\/blog\/the-physical-therapists-guide-to-therapy-cap\/\">physical therapy<\/a> service\/ procedure for specificity. This leads to suitable reimbursements from the insurance company to the provider. There are two levels namely,\u00a0<strong>Level I CPT Modifiers\u00a0<\/strong>which comprise of two numeric digits, and\u00a0<strong>Level II HCPCS Modifiers\u00a0<\/strong>comprise of two digits (Alpha\/ Alpha-numeric characters)<\/li>\n<li><strong>Modifier 59 <\/strong>is the most commonly used because it is used when no other appropriate modifier is available.<\/li>\n<li><strong>National Correct Coding Initiative (NCCI)<\/strong>\u00a0has recognized certain physical therapy practices that are commonly performed together. These are known as the\u00a0<strong>edit-pairs<\/strong>. If a CPT code is part of these pairs, then reimbursements are done for only one of the pairs.<\/li>\n<li><strong>Modifier XE, XP, XS, XU<\/strong>\u00a0are used to circumvent edit-pair limitations.<\/li>\n<li><strong>Modifier KX <\/strong>is used when the patient has reached the maximum number of years of therapy sessions. The physical therapist must to provide medical justification for all bills with the KX modifier<\/li>\n<li><a href=\"https:\/\/atlanticrcm.com\/medical-billing-coding.php\"><strong>Billing for Telehealth <\/strong>services<\/a> including physical therapy is maintained and administered by each state. The physical therapy service providers must follow the laws and regulations, in the respective states in which they operate.<\/li>\n<li><strong>Billing mistakes: <\/strong>Medicare and a few other insurance companies do not reimburse bills that include 97014 \u2013 Electric Simulation Therapy and\/ or 97010 \u2013 Hot\/ Cold Packs. 97302 \u2013 Attended Electric Simulation Therapy can be used for reimbursement.<\/li>\n<\/ul>\n<p>Physical Therapists must document medical necessity for services represented by 97012 \u2013 Mechanical Traction, 97018 \u2013 Paraffin Bath, and 97028 \u2013 Ultraviolet.<\/p>\n<p>Using appropriate CPT codes and modifiers ensures higher revenue for the physical therapy service provider. Practices who choose to work with HIPAA and PCI-compliant <a href=\"https:\/\/atlanticrcm.com\/\">professional medical billing services<\/a> can address denials and address revenue leakages.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rejected or delayed reimbursements, after spending hours to rehabilitate injured patients can be demeaning for physical therapy practices. Claim denials, rejections, and delays can hurt the<span class=\"excerpt-hellip\"> [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":265,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-264","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blogs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Your Go-To Guide to Medical Coding for Physical Therapy - Atlantic RCM<\/title>\n<meta name=\"description\" content=\"Medical billing for physical therapy is complex. laim denials, rejections, and delays can hurt the continuity of the business for the healthcare providers.\u00a0\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atlanticrcm.com\/blog\/your-go-to-guide-to-medical-coding-for-physical-therapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Your Go-To Guide to Medical Coding for Physical Therapy - 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