Your Go-To Guide to Medical Coding for Physical Therapy

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.

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 current procedural terminology (CPT) codes.

CPT codes are managed and updated every year by the American Medical Association. Changes and updates for the year 2021 include:

• 329 editorial changes
• 206 new codes
• 69 revised code descriptors, and
• 54 deleted code.

63% of the new codes involve new technology or services, implemented due to the COVID-19 pandemic. There are changes in nearly every section. Hence, correct coding is dependent on understanding the latest coding resources and the associated guidelines.

10 of the most commonly used CPT codes:

Key points to consider while billing includes:

• Medicare: untimed and timed codes: Untimed codes can be billed only once per session. The physical therapist 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.
• Modifier codes are two-digit codes that add information or changes the description of a physical therapy service/ procedure for specificity. This leads to suitable reimbursements from the insurance company to the provider. There are two levels namely, Level I CPT Modifiers which comprise of two numeric digits, and Level II HCPCS Modifiers comprise of two digits (Alpha/ Alpha-numeric characters)
• Modifier 59 is the most commonly used because it is used when no other appropriate modifier is available.
• National Correct Coding Initiative (NCCI) has recognized certain physical therapy practices that are commonly performed together. These are known as the edit-pairs. If a CPT code is part of these pairs, then reimbursements are done for only one of the pairs.
• Modifier XE, XP, XS, XU are used to circumvent edit-pair limitations.
• Modifier KX 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
• Billing for Telehealth services 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.
• Billing mistakes: Medicare and a few other insurance companies do not reimburse bills that include 97014 – Electric Simulation Therapy and/ or 97010 – Hot/ Cold Packs. 97302 – Attended Electric Simulation Therapy can be used for reimbursement.

Physical Therapists must document medical necessity for services represented by 97012 – Mechanical Traction, 97018 – Paraffin Bath, and 97028 – Ultraviolet.

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 professional medical billing services can address denials and address revenue leakages.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com