Physiotherapy Billing CPT Codes, Guidelines & Modifiers

Touseef Riaz

April 26, 2022

Physiotherapy-Billing-CPT-Codes

Physiotherapy billing solutions consist of restoring, maintaining, and making the most of patients:

  • Mobility
  • Well-being
  • Function

Physical therapists spend a significant amount of time with the patients to help them through their injury, health, and rehabilitation. Proper medical billing for physiotherapy ensures that the time spent by physicians is appropriately reimbursed.

Submitting medical claims for physical therapy can be a complex process for maximum reimbursement. This is the reason why physicians and healthcare providers must have a vast understanding of the physiotherapy billing codes. Following are some of the most common physiotherapy codes in medical billing.

Physiotherapy-Billing-CPT-Codes

Physiotherapy Billing Codes:

Common physiotherapy billing codes are as follows:

    • The therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility. It comprises specially designed exercises and activities to help patients gain better mobility and fitness levels. It also involves physical as well breathing exercises.
    • Neuromuscular Re-Education: Includes activities that facilitate the re-education of movement, balance, posture, coordination, and kinesthetic sense. The therapeutic procedure also involves or/and proprioception for sitting; or/and standing activities. The physician performs it to reduce impairments and restore function through the application of clinical skills and/or services.
    • Gait Training: proper ways of various exercises like climbing stairs are instructed to the patient. This training focuses on one or more areas that assist them in walking comfortably and without strain for a period of 15 minutes.
    • Manual Therapy: Soft tissue mobilization, joint mobilization, manipulation, manual traction, muscle energy techniques, and manual lymphatic drainage. It involves the treatment of soft tissue and joints by controlled pressure and movements.
    • Group Therapy: The physical therapist provides and supervises the therapeutic procedures to a group (two or more) of patients at the same time, e.g., exercise therapy.
    • Therapeutic Activities Involve any dynamic activities that are designed to improve functional performance. It requires direct contact with the patient. Use this code for each 15 minutes of activity.
    • Self-Care/Home Management Training: Includes a variety of techniques like
      • ADL (Active Daily Living) training
      • Compensatory training
      • Safety procedures/instructions
      • Meal preparation
      • Use of assistive technology devices or adaptive equipment
      • To provide proper instruction to the patient, especially in cases of recovery from acute disease.
    • Physical Performance Test or Measurement; Includes tests such as the musculoskeletal and functional capacity of the patient. It involves measuring an aspect of physical performance. The provider assesses the patient’s physical performance and completes a written report.
    • Prosthetic management and training: includes direct one–on–one patient contact. This procedure includes the assessment, fitting, and/or training in the use of a prosthesis. Report this code for each 15 minutes of the initial encounter.
    • Physical therapy evaluation: low complexity, requiring these components: It involves history to rule out any adverse factors that will affect care and assess one to two elements. Typically involving 20 minutes of face–to–face time with the patient or family or both.
    • Physical therapy evaluation: moderate complexity; Includes: history to rule out any adverse factors that will affect care and assesses three or more elements. It typically involves 30 minutes of face–to–face time with the patient or family or both.
  • CPT Code 97163
    • Physical therapy evaluation, high complexity: It typically involves 45 minutes of face–to–face time with the patient or family or both. It also includes the patient’s history with three or more personal factors affecting care and examinations of four or more elements.

Types of Billing codes: Timed & Untimed

In rehabilitation procedures, there are two types of billing codes; timed and untimed. A physician or physiotherapist is reimbursed with a predetermined fee for an untimed code. With this, the amount of time spent in the procedure isn’t calculated in reimbursement, and the physician is reimbursed per treatment session. However, the physiotherapist is reimbursed for timed codes based on the one-on-one time they spent with the patient for skilled interventions. The physician can only bill untimed codes one time per treatment session. But timed codes can be billed multiple times per treatment session.

Each timed code represents 15-minutes of a treatment session. However, treatment sessions might not always be split into 15 minutes, and this is why the 8-minute rule was devised. Based on this 8-minute rule, the physician must spend a minimum of 8 minutes performing the treatment to bill one unit. Here is how to calculate the number of units, add up the total minutes spent and divide them by 15 (to bill for timed codes).

Modifiers for Physiotherapy Billing Codes:

Modifiers in medical billing are used to report additional information regarding the procedures performed by the physician. They comprise two characters; digits or alphabets, e.g., modifier 59 or modifier GP. When it comes to physiotherapy, using the modifier 59 can get a little confusing. Modifier 59 in medical billing is to report a “distinct procedural service.” It represents that the procedure performed by the physician is distinct and independent of the other procedure performed on the same day. If there is no other modifier appropriate to use, modifier 59 should be used.

Several physiotherapy services are linked with one another and are commonly performed together, also known as “edit pairs.” While reporting codes belonging to these pairs, only one of them will be reimbursed. This is why modifier 59 should be used in medical billing while reporting linked or distinct services.

Billing physiotherapy for Telehealth

Telehealth has seen a vast increase and rise in the healthcare industry. Various specialties have shifted their services remotely, and this also includes physical therapy. To expand the healthcare practice, offering virtual consultations is beneficial for physicians. However, physical therapy billing services for Telehealth come with several challenges as well.

Common Billing Errors in Physiotherapy Billing:

Several coding errors can result in lost payments and a lower reimbursement rate, affecting the revenue cycle. However, submitting clean medical claims leads to faster payments, lesser claim denials, a higher reimbursement rate, and an improved revenue cycle. Following are some of the most common coding errors in physiotherapy medical billing:

  • Using an incorrect or non-billable code:

Eight minutes is equal to one unit for timed codes. Some codes are non-billable or have a limit, i.e., can only be reimbursed up to one unit per visit. The documentation must clearly state the medical necessity behind performing that particular service. On the other hand, some codes aren’t reimbursed by Medicare or other insurance payers if billed.

For this reason, the healthcare practice must be up-to-date with all the coding requirements and guidelines of the Medicare and insurance payers. Because billing the incorrect code can lead to the claim being denied or rejected, affecting the revenue cycle of the healthcare practice.

  • Overusing a specific code or billing a wrong code:

Correct billing for physical therapy services requires using specific and accurate codes. A wide range of physiotherapy services fall under the therapeutic procedures; using the specific code leads to proper medical billing. Using two linked services can also result in Medicare double-billing physiotherapy procedures.

  • Using incorrect modifier:

There are various modifiers in medical billing; using the correct one significantly impacts the revenue cycle. However, using the incorrect modifier can lead to lost payments. For instance, in physiotherapy, modifier 59 is used to report distinct procedural services for linked services. In case the correct modifier is not used, only one of the linked services will be reimbursed.

Outsourcing Physiotherapy Billing Services:

There are several benefits of outsourcing the services to a well-reputed medical billing company. Some of the major benefits of outsourcing include:

  • Lesser errors in medical claims
  • A team of highly experienced professionals handling physiotherapy direct billing.
  • More focus on providing safe and quality patient care
  • Lesser claim denials and higher clean claim rate
  • Faster payments and a higher reimbursement rate
  • Improved revenue cycle

Introduction to Physiotherapy:

Physiotherapy or physical therapy plays a vital role in restoring normal movement and function of the body. It can help people with various injuries, illnesses, and disabilities. Physiotherapists are the specialists performing the treatment sessions. These specialists deal with body movement rather than focusing on the noticeable injury. They focus on the root cause.

Physiotherapy can be helpful for:

There are several conditions physiotherapy can be helpful for; these include:

  • Bones, joints & muscles:
    • Back pain
    • Neck Pain
    • Sports injuries
    • Shoulder pain
    • Arthritis
  • Brain or Nervous system conditions or loss of mobility due to:
    • Parkinson’s disease
    • Trauma to the spine or brain
    • Stroke
    • Multiple Sclerosis (MS)
  • Blood circulation and heart conditions:
    • Rehabilitation
    • Heart attack
  • Breathing issues and lunge disorder:
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Cystic fibrosis
    • Asthma
  • Conditions due to cancer treatment or palliative care, for instance:
    • Fatigue
    • Swelling
    • Stiffness
    • Loss of muscle strength
    • Pain

Benefits of Physiotherapy:

Physiotherapy comes with several benefits in restoring the normal function at the affected point and aiding in the prevention. Trained and well-specialized professionals perform physical therapy. Various conditions (mentioned earlier) have shown significant improvement with physiotherapy. Following are the benefits of physiotherapy:

  • Reduction in pain
  • It helps manage the pain and avoid the surgery
  • Improvement in strength
  • Improvement in coordination
  • Reducing dependency on pain medications
  • Improvement in cardiovascular functioning
  • Increased lung capacity
  • Aids in management as well as prevention of sports-related injuries
  • It plays a vital role in managing conditions related to heart and diabetes
  • Besides helping with physical health, it also aids in improving mental health.

Frequently Asked Questions (FAQs)

1. What is physiotherapy in medical billing?

Physiotherapy is an allied health profession and is also known as physical therapy. Physical therapists spend a significant amount of time with the patients to help them through their injury, health, and rehabilitation. Proper medical billing for physiotherapy ensures that the time spent by physicians is appropriately reimbursed.

2. What are common physiotherapy billing errors?

Errors in medical billing directly affect the revenue cycle and reimbursements of the healthcare provider and physician. Some physiotherapy codes are non-billable or have a limit, i.e., can only be reimbursed one unit per visit. Using an incorrect code and wrong modifiers are the common physiotherapy billing errors.

3.  What does physiotherapy billing mean?

Medical billing for physiotherapy ensures that the time spent by physicians is reimbursed for the services they render. Submitting medical claims for physical therapy can be a complex process for maximum reimbursement. And submitting clean medical claims leads to faster payments, lesser claim denials, a higher reimbursement rate, and an improved revenue cycle.

https://www.gethealthie.com/blog/guide-to-physical-therapist-billing-cpt-codes

https://etactics.com/blog/common-cpt-codes-for-physical-therapy#Common-Physical-Therapy-CPT-Codes=

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