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What are some commonly used CPT codes in Physical Therapy?

“Crack the Code: Mastering Physical Therapy’s CPT Secrets!”
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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.

Difference Between ICD-10 and CPT Codes:

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: 

CPT codes used in physical therapy

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).  

Common CPT Codes in Physical Therapy

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: 

  1. Codes for initial Evaluations
  2. Code for re-evaluations
  3. Codes for Treatment

Codes for initial Evaluations:

Evaluations are crucial in physical therapy to assess a patient’s condition and develop a treatment plan.
Infographic code for initial evalution
Common evaluation CPT codes include:
  • 97161: Physical therapy evaluation, low complexity.
  • 97162: Physical therapy evaluation, moderate complexity.
  • 97163: Physical therapy evaluation, high complexity.

Codes for Re-evaluations:

Re-evaluations are essential for assessing a patient’s progress and modifying treatment plans.

The common re-evaluation CPT code is:

  • 97164: Re-evaluation of physical therapy established plan of care.

This code captures the time and effort spent on reviewing the patient’s response to treatment and making necessary adjustments.

Codes for Treatment:

Treatment codes encompass a variety of interventions and therapies used in physical therapy.
Common treatment CPT codes
Common treatment CPT codes include:
  • 97110: Therapeutic exercises. ((e.g. Structured movement, coordination).
  • 97140: Manual therapy techniques (e.g., improve mobility,  enhance function).
  • 97530: Therapeutic activities (e.g., gait training, balance exercises).
  • 97535: Self-care/home management training (e.g., activities of daily living).
Accurate coding of treatment services ensures proper documentation, billing, and reimbursement for the interventions provided by physical therapists.

Procedure Codes in Physical Therapy

In physical therapy, procedure codes play a crucial role in documenting and billing for the services provided. Understanding the different types of procedure codes is essential for accurate record-keeping and reimbursement.

(a) Timed-based Physical Therapy Procedure Codes:

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:

Timed-based Physical Therapy Procedure Codes

Therapeutic Exercises (97110):

  • Therapeutic exercises focus on improving strength, flexibility, and range of motion. This code encompasses activities such as stretching, strengthening exercises, and neuromuscular re-education.

Neuromuscular Re-education (97112):

  • This code covers interventions designed to restore or enhance function by addressing impairments of the neuromuscular system. Techniques include proprioceptive training, balance exercises, and coordination activities.

Manual Therapy (97140):

  • Manual therapy involves skilled hands-on techniques to mobilize or manipulate joints and soft tissues.

Therapeutic Activities (97530):

  • Therapeutic activities involve dynamic, purposeful tasks to improve functional abilities. Examples include wheelchair mobility training, dynamic balance training, and aquatic therapy.

(b) Untimed Physical Therapy Procedure Code:

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:

Ultmiate physical therapu

Evaluation (97161-97168):

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

modifier code

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.

Documentation Guidelines for CPT Coding in Physical Therapy

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.

Final thoughts

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.

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