
Physiotherapy plays a vital role in patient care because it is needed by those who have musculoskeletal conditions, people who have undergone surgery, and patients with neurological diseases. For proper billing and reimbursement of these services, the physical therapist employs procedural codes commonly known as CPT codes. These codes refer to the various interventions that are delivered during a session and ensure that therapists can cover with the insurance companies, so they are paid adequately.
This blog serves as a comprehensive guide for physical therapists including the significance of accurate coding, list of common CPT codes, and mistakes to avoid when using CPT codes for physical therapy.
What Are Physical Therapy CPT Codes?
Physical Therapy Current Procedural Terminology (CPT) is a set of numerical or alphanumeric codes used by a physical therapist to document the kind of service rendered to the patient. These codes are very useful in billing insurance companies to get the reimbursements for services provided. CPT codes enable providers to accurately bill for their services and receive the correct payment for their rendered services. These codes are employed to identify all manner of treatments, including therapeutic exercise and manual therapy, gait training, and ultrasound therapy. Physical therapists can also standardize their billing processes through CPT codes, which will enhance the treatment’s clarity and efficiency when it comes to insurance providers.
Why Accurate CPT Coding is Important in Physical Therapy?
Accurate CPT coding in physical therapy is essential for several reasons, primarily related to proper reimbursement, compliance, and maintaining a steady cash flow for the practice:
Ensures Proper Reimbursement
Accurate coding is very important to make sure that the physical therapists are paid adequately for the services that they offer. By using the correct CPT code, insurance companies are in a position to differentiate the kind of treatment given, hence ensuring the insurance company makes the right payment without bounced checks or late payments.
Reduces Claim Denials
Inaccurate or subjective coding can result in the denial of claims that must be resubmitted and followed up. Proper CPT coding reduces the likelihood of denial as it offers clear and coherent information to the payers.
Maintains Compliance
The use of correct coding is very important in order to meet regulatory requirements. Misleading coding will therefore attract audits and may lead to financial penalties or fraud allegations.
Improves Efficiency
When done correctly, CPT codes help in improving the billing cycle and decreasing the workload on the clerical staff. It helps billing staff to work more effectively and get through a number of claims as quickly as possible to prevent any delays in payments.
Common CPT Codes Used in Physical Therapy
Physical therapy is made up of several treatment types, with each of them described by a different CPT code number. Here are some of the most commonly used CPT codes in physical therapy:
97110: Therapeutic Exercise: This code is used for those exercises that are meant to build strength, muscular endurance, joint flexibility, and muscle elongation. Treatment programs constituted of therapeutic exercises are charged in 15-minute slots.
97112: Neuromuscular Re-education: Neuromuscular re-education is employed when there’s a problem with motor control, stability, function, alignment, or sense of body position in space that needs to be corrected because of an injury or neurological disease.
97116: Gait Training Therapy: Gait training involves informing the client on how to move in the best way possible or even with the aid of equipment such as crutches, walkers, or canes.
97140: Manual Therapy: This code includes all types of hands-on skills like mobilization, manipulation, or myofascial release that aim to treat pain and motion disorders in the joint or soft tissue.
97530: Therapeutic Activities: Therapeutic activities include functional activities, like using different muscle groups or reaching, to reduce the clients’ limitations in the various activities of daily living. These activities are also charged in 15-minute intervals.
97535: Self-Care/Home Management Training: This code signifies training to enable the patient to be more self-reliant in the home environment. They range from activities like teaching adaptive clothing or bathing, grooming, or other activities of daily living (ADLs).
CPT Codes | Description | Purpose |
97110 | Therapeutic Exercise | Improve strength, flexibility, endurance, and range of motion |
97112 | Neuromuscular Re-education | Address movement, balance, coordination, posture, and proprioception |
97116 | Gait Training Therapy | Improve walking ability, often involving assistive devices like crutches or walkers |
97140 | Manual Therapy | Techniques like mobilization manipulation, or myofascial release to relieve pain |
97530 | Therapeutic Activities | Functional activities to enhance daily living skills, such as lifting and reaching |
97535 | Self-Care/Home Management Training | Training for activities of daily living (ADLs) to promote independence at home |
Here are additional CPT codes that are often used in physical therapy:
97012: Mechanical Traction Therapy: This code corresponds to mechanical traction, a procedure that implies the utilization of a device to create traction of the spine in order to decrease tension on the disc and/or nerves.
97124: Massage Therapy: It is applied for stress relief, alleviation of pain, and to increase blood flow. This code refers to the therapeutic massaging conducted by physical therapists.
97032: Electrical Stimulation (Manual): Electrical stimulation (e-stim) is often employed to excite nerves and muscles. This code is used for electrical stimulation that is applied to the patient directly by the therapist.
97033: Iontophoresis: Iontophoresis is a technique of applying a small current to the transdermal delivery of medication to targeted tissues and is popular for pain and inflammation.
97034: Contrast Baths: Of the many treatments administered in hydrotherapy, one of them involves switching between hot water and cold water with the aim of improving blood flow and allaying pain. This particular code belongs to this kind of therapy.
97036: Hubbard Tank: The Hubbard tank is a kind of immersion bath that involves full body immersion in water and is also referred to as wet therapy. This code relates to treatments that are offered utilizing a water type of whirlpool tub that can cover the whole body of the client.
97150: Group Therapy: This code is applied in case a number of patients are treated collectively in one session, concentrating on the general treatment exercises or games.
97750: Physical Performance Test or Measurement: This code is used each time a physical therapist conducts an assessment in the form of a functional test or a measurement with the view of assessing the strength, balance, or any other physical ability of a given patient.
97760: Orthotic Management and Training: This code is used when a patient is being trained to use orthotic appliances in mobility and in function.
97761: Prosthetic Training: Prosthetic training entails availing of an artificial limb for a patient and teaching them how to make use of the same—how to properly handle the prosthesis.
CPT Codes | Description |
97012 | Mechanical Traction Therapy (spinal decompression) |
97124 | Massage Therapy (therapeutic massage for pain relief and relaxation) |
97032 | Electrical Stimulation (Manual) (stimulating nerves and muscles manually) |
97033 | Iontophoresis (delivery of medication using low electrical current) |
97034 | Contrast Baths (alternating hot and cold baths to improve circulation and reduce pain) |
97036 | Hubbard Tank (full-body hydrotherapy using a specialized whirlpool) |
97150 | Group Therapy (therapeutic activities provided to a group of patients) |
97750 | Physical Performance Test or Measurement (evaluation of strength, balance, or function) |
97760 | Orthotic Management and Training (training in the use of orthotic devices) |
97761 | Prosthetic Training (training in the use of artificial limbs) |
97542 | Wheelchair Management/Training (training for effective wheelchair use) |
Timed vs. Untimed Physical Therapy CPT Codes
Physical therapy CPT codes can be categorized into two types: timed and untimed. It is therefore important to understand the difference in order to ensure that billing is accurate and reimbursement has been optimized.
Timed CPT Codes
The timed codes are those that are charged according to the time taken to provide a certain service. These codes refer to one patient-therapist interaction, implying that the therapist is engaged with the patient during the billed time. Timed CPT codes are reported in 15-minute units, based on what has been known as the ‘8-minute rule,’ whereby a billed time requires a minimum of 30 minutes of medical service, of which at least 8 minutes must be spent in treatment.
Examples of timed CPT codes in physical therapy include:
- 97110: Therapeutic Exercise
- 97112: Neuromuscular Re-education
- 97140: Manual Therapy
- 97530: Therapeutic Activities
The 8-Minute Rule: The 8-minute rule is used to determine the number of units to bill for timed CPT codes. Here’s a quick breakdown:
- 8 – 22 minutes = 1 unit
- 23 – 37 minutes = 2 units
- 38 – 52 minutes = 3 units
- 53 – 67 minutes = 4 units
Untimed CPT Codes
The untimed codes, on the other hand, are reimbursed by the provider for each session of the service regardless of the amount of time the service is taken. These codes signify processes that are not time-bound, implying that the therapist need not be in touch with the patient for a specific number of times within a day.
Examples of untimed CPT codes in physical therapy include:
- 97010: Hot/Cold Packs – Application of a hot or cold pack.
- 97012: Mechanical Traction – Use of mechanical devices to relieve pressure on the spine.
- 97014: Electrical Stimulation (Unattended) – Electrical stimulation applied without continuous supervision.
Key Differences
- Timed Codes: Allow billing in 15-minute units, based on direct treatment time.
- Untimed Codes: Billed only once per session, regardless of how long the service takes.
Understanding the difference between timed and untimed codes is imperative in preventing billing mistakes, conforming to regulatory requirements, and optimizing PT reimbursement.
Mistakes to Avoid When Using CPT Codes for Physical Therapy Billing
An understanding of CPT codes is crucial in order to receive reimbursement, to prevent denial of claims, and to stay on the right side of the law. However, it is very usual to make mistakes in billing for physical therapy, and this can result in delayed payments or even audits. Below are common mistakes to avoid when using CPT codes for physical therapy billing:
Incorrect Code Selection
One of the most common errors is choosing the improper CPT code. It is highly advisable to select a code that reflects the nature of the offered service. If you accidentally incurred a similar but incorrect code, then the claim will be denied. It is also important to familiarize themselves with changes in codes and guidelines, as these are revised every year.
Failing to Apply the 8-Minute Rule Correctly
Regarding timed codes, there are significant mistakes that many therapists make when applying the eight-minute rule for the code. Any CPT code that is a timed code must be reported in base units of 15 minutes, and these units must be supported by at least eight minutes of actual treatment. This means if the time shared on each service is wrongly presumed or if recorded in an improper method, more billing or less billing can happen.
Billing Group Therapy as One-on-One
Another error is claiming group therapy codes (97150) for one-on-one sessions that results in non-compliance. It is advisable to use a group therapy code when treating multiple patients at the same time in order to ensure that the right code is charged.
Inaccurate Documentation
Documentation forms the foundation for proper billing; that is why it should be done appropriately. Because of inadequate, comprehensive documentation of treatment rendered, it proves difficult to explain the application of specific CPT codes. For instance, notes should include:
- Type of service provided (e.g., manual therapy or therapeutic exercise).
- Duration of each service.
- Patient progress. Incomplete or vague documentation is a major reason for claim denials.
Not Using Appropriate Modifiers
CPT modifiers serve to provide additional details about a reported code or service, or to distinguish a specific service from others provided on the same day. For instance, modifier 59 helps inform billers that the particular service billed is distinct from other services delivered on the same day. Claim rejection is likely to occur when a clinician neglects to employ particular modifiers properly.
Overbilling or Underbilling Units
Overcharging or undercharging is common when the right number of units has been either calculated wrongly or billed inappropriately. Overbilling poses a great risk in terms of compliance, whereas underbilling poses a risk of loss of revenues. It is important for therapists to confirm the units charged with those that have been spent and the services offered.
Conclusion
Appropriate CPT codes regarding physical therapy must be understood and applied in the billing process to prevent claim denial and increase revenue. For physical therapy billing to be effective, it demands a lot of professionalism, compliance with payer rules, as well as producing detailed documentation. Being updated on the most used CPT codes together with their distinctions, implementing the 8-minute rule, and general compliance with best practices can enhance your billing considerably.
If you’re having trouble with the calculations of CPT codes and billing, there is a possibility of hiring a professional service and outsourcing for billing to Medheave Medical Billing Services. We have a team of experts who can handle everything and will ensure that you spend most of your time attending to patients instead of working on billing issues.
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