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Physical Therapy (PT) is a growing field in healthcare. It helps individuals manage pain, recover from surgery or injury, and improve mobility through physical exercise. One of PT’s most important aspects is using Current Procedural Terminology (CPT) codes to bill for services provided accurately.
Knowing which CPT codes are commonly used in physical therapy can help streamline billing processes and ensure accuracy when submitting claims.
Physical therapists face certain challenges when deciding which CPT codes to use. Because the codes vary depending on the type of treatment provided, it can be difficult to know which code best applies to each service.
Fortunately, there are some common CPT codes used in physical therapy that can serve as a guide and help simplify the billing process. Before delving deeper into CPT codes, it’s essential to distinguish between CPT and ICD-10 codes, as they serve distinct purposes in medical coding.
The International Classification of Diseases (ICD-10) codes are used for medical diagnosis, whereas Current Procedural Terminology (CPT) codes are used for billing healthcare services – such as physical therapy. ICD-10 codes provide a standard language to describe the disease or condition being treated, while CPT codes are used to identify the services provided by the physical therapist.
Understanding the differences between these codes and their respective uses is essential in ensuring accurate billing and reimbursement for services rendered.
An example of ICD-10 and CPT codes used in physical therapy is as follows:
A patient seeks physical therapy for a shoulder injury with the ICD-10 code of M75.22 (shoulder bursitis). The PT evaluates and treats the condition using the CPT codes 97161 (evaluation) and 97110 (therapeutic exercise).
Physical therapy employs a variety of techniques and treatments, so the list of CPT codes used in physical therapy can be quite extensive. However, there are some codes that are more commonly used than others.
The following three categories are some of the most common CPT codes used in physical therapy:
Re-evaluations are essential for assessing a patient’s progress and modifying treatment plans.
The common re-evaluation CPT code is:
This code captures the time and effort spent on reviewing the patient’s response to treatment and making necessary adjustments.
Timed-based procedure codes are used when the therapy services are provided for a specific duration. The therapist’s time spent on a particular service determines the billing and reimbursement.
Here are the timed-based physical therapy procedure codes:
Therapeutic Exercises (97110):
Neuromuscular Re-education (97112):
Manual Therapy (97140):
Therapeutic Activities (97530):
Untimed procedure codes are used when therapy services are not billed based on time but rather based on the completion of specific procedures or services.
Here are the untimed physical therapy procedure codes:
Evaluation codes are used for the initial assessment of a patient’s condition and the formulation of an individualized treatment plan.
Orthotic and Prosthetic Management (97760-97762):
Orthotic and prosthetic management involves the fitting, adjustment, and monitoring of braces, splints, or prosthetic devices. This code includes the evaluation, fitting, and training associated with the use of these devices.
Gait Training (97116):
Gait training focuses on improving a patient’s ability to walk.It includes activities such as balance exercises, weight shifting, and the use of assistive devices like crutches or walkers.
Modifier codes are an important part of physical therapy billing. They provide additional information about the service provided and can be used to describe services in more detail. Modifiers can also help distinguish between similar services performed on different dates or by different providers.
Modifier 59 and Modifier XU are two of the most commonly used modifiers in physical therapy. Modifier 59 is used to indicate a distinct service from other services being performed on the same day, while Modifier XU is used when no other procedure code accurately describes the service provided.
Providers use Modifier 59 to indicate that a distinct service has been provided on the same day as another service. This is especially helpful when describing services that are typically bundled together, such as evaluation and treatment services.
Modifiers XE, XP, and XS are used when there is no other procedure code that accurately describes the service provided. These modifiers indicate teaching, training, or supervision services that are not included in any other procedure codes and must be billed separately.
Finally, Modifier KX can be used in physical therapy to indicate that all necessary components of the service were provided. This modifier helps providers differentiate between services that have been partially completed and those that are fully completed.
Accurate documentation is essential for proper billing of services provided by physical therapists. This includes providing detailed information on the patient’s diagnosis, the treatments and interventions used, and the results achieved.
When documenting physical therapy services, it is important to ensure that all relevant information is included to help guide the selection of an appropriate CPT code. It includes the patient’s diagnosis, treatment plan, type and duration of services provided (including any special instructions), as well as any progress notes or outcomes.
It is also important to be aware of the documentation guidelines set forth by individual insurance companies. These guidelines may differ from company to company, so it is important to familiarize yourself with the specific requirements for any payers you are working with.
Physical therapy is an important part of healthcare and CPT codes for PT are a key component to accurately billing for services rendered. Knowing which CPT codes are commonly used in physical therapy, including procedure codes, modifier codes, and time-based codes can help streamline the billing process.
With this knowledge, physical therapists can ensure accurate record-keeping and reimbursement when submitting claims. By understanding how ICD-10 and CPT codes differ from each other, providers will be better equipped to select the right code for their patient’s condition or service provided.
To enhance your billing efficiency, consider partnering with professional billing services. Their expertise and knowledge will help you navigate the complexities of billing, maximizing revenue and allowing you to focus on providing exceptional care to your patients.