Which Cpt Codes Should Pts Ots And Slps Use To Bill For Remote And Virtual Care Services
In light of the COVID-19 pandemic, CMS and many commercial payers began allowing rehab therapists to provide and bill for certain remote care services. In most cases, therapists bill for true telehealth services using the same CPT codes they would bill for services provided in the clinic .
Outside of true telehealthand based on temporary, crisis-related regulatory provisionstherapists may bill the following codes when providing remote patient care:
For more details on these codesincluding payer coverage and required modifiersdownload this free Telehealth Billing Quick Guide for PTs, OTs, and SLPs.
Kinesio Taping / Mcconnell Taping / Taping
Kinesio taping is a method of taping utilizing a specialized type of tape. It differs from traditional white athletic tape in the sense that it is elastic and can be stretched to 140 % of its original length before being applied to the skin. It subsequently provides a constant pulling force to the skin over which it is applied unlike traditional white athletic tape. The fabric of this specialized tape is air permeable and water resistant and can be worn for repetitive days. Kinesio tape is being used immediately following injury and during the rehabilitation process. However, its effectiveness has yet to be established.
The American College of Occupational and Environmental Medicine’s practice guidelines on “Evaluation and management of common health problems and functional recovery in workers” did not recommend taping or kinesiotaping for acute, subacute, or chronic LBP, radicular pain syndromes or other back-related conditions.
What Is The Difference Between Timed And Untimed Cpt Codes
Timed codes are just as they soundcodes used for variable, timed services, typically in increments of 15 minutes. Untimed codes are service-based codes that do not report time spent with patients. Practitioners use untimed CPT codes for a single treatment with a predetermined flat fee. You should report this billing code each time you perform a treatment for a patient.
Timed CPT codes, used only for skilled intervention, are based on the amount of time you spend with the patient. You may use multiple units of a single timed code for a single session with a patient, depending on the duration of the therapy in question.
Timed Vs Untimed Codes For Medicare
For rehabilitation providers that bill Medicare, there are two different types of billing codes: untimed and timed codes. When using untimed codes, the PT is paid a predetermined fee, no matter the time spent on treatment. These codes can be billed once per treatment session. Timed codes are reimbursed based on the time spent working 1:1 with their patient, and include only skilled interventions. Timed codes can be billed multiple times per session, whereas untimed codes can only be billed once per session.
Technically, each timed code represents 15 minutes of treatment. However, because treatment may not always be split into perfect 15 minute segments, the 8-Minute Rule was devised. In order to bill one unit of time for a code, the provider must spend at least 8 minutes performing the service. To calculate the number of units to bill for timed codes, add up the total minutes spent and divide by 15. This will give you the number of units you can bill. If the remainder is more than 8, you can bill an additional unit if it’s 7 or under, you must bill for the minimum units.
If you need help organizing past sessions per these rules, or billing clients for treatments, Healthieâs Free Starter Plan makes it easy and streamlines future client scheduling and payment processing. Simply click here to get started today.
License For Use Of Physicians’ Current Procedural Terminology Fourth Edition
End User Point and Click Amendment:CPT codes, descriptions and other data only are copyright 2021 American Medical Association. American Medical Association. All Rights Reserved . CPT is a trademark of the American Medical Association .
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services . You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, .
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Myofascial Physical Therapy For Pelvic Pain Syndromes
Pontari and Giusto described new developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome . Symptoms in men with chronic prostatitis/CPPS appear to cluster into a group with primarily pelvic or localized disease, and a group with more systemic symptoms. Several other chronic pain conditions can be associated with chronic prostatitis/CPPS, including irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome. Markers of neurologic inflammation and autoimmune disease parallel changes in symptoms after treatment. Treatment options include new alpha-blockers, psychological intervention, and prostate-directed therapy. The areas of acupuncture and pelvic floor physical therapy/myofascial release have received increased recent attention and appear to be good options in these patients. Future therapy may include antibodies to mediators of neurogenic inflammation and even treatment of bacteria in the bowel. The authors concluded that the diagnosis of chronic prostatitis/CPPS must include conditions traditionally outside the scope of urologic practice but important for the care of men with chronic pelvic pain. The treatment is best done using multiple simultaneous therapies aimed at the different aspects of the condition.
The European Association of Urologys guidelines on chronic pelvic pain stated that There are insufficient data on the effectiveness of myofascial physical therapy for the treatment of PPS .
A Patient Undergoing Therapy Treatment Demonstrates An Unexpected And Significant Change In Status
This could include any improvement, decline, or other change in functional status that:
Example: Youre treating a 39-year-old hairstylist for right rotator cuff impingement, but you notice a severe decline in the range of motion that you did not anticipate when you established the original treatment plan. In this instance, you would need to further evaluate the patient to understand the root cause of the decline.
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A Quick Review Of Cpt Codes And Icd
CPT stands for Current Procedural Terminology and are published by the American Medical Association. Ranging from 00100 to 99499, the CPT codes are used to describe medical, surgical, and diagnostic services and procedures.
Medical professionals like Physical Therapists use CPT codes to classify the treatment of diagnoses. ICD-9 Codes are used to classify signs, symptoms, injuries, diseases, and conditions.
The idea is that the CPT code matches up logically with the ICD-10 code . If the CPT code doesnt support the ICD-10 code, youll have a problem and youll likely have trouble getting reimbursed.
A Current Patient Develops A Newly Diagnosed Related Condition
If you are treating a patient, and he or she presents with a second diagnosis that is either related to the original diagnosis or is a complication resulting from the original diagnosis, youll need to complete a re-evaluation and create an updated plan of care.
Example: A 15-year-old high school soccer player has an original plan of care for right patellofemoral pain syndrome, and she obtains a second referral for similar symptoms in the left knee.
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Worker Comp Physical Therapy Services
When an injury or illness is work related, a patient would want you to bill the services to WC carrier rather normal primary healthcare insurance.
In case of physical therapy, you would usually need to take prior authorizations for services a physical therapist is going to perform.
The codes for physical therapy for WC are the same process and the amount paid to the therapist can vary.
Common Physical Therapy Cpt Codes
The most commonly used CPT codes for Physical Therapy are listed below. For example, the CPT code for therapeutic exercise is 97110. The CPT code is listed on the left, the name of the code is in the middle and the description is in the right column.
What code would you use for PROM if not manual therapy? Almost always I combine PROM with joint mobilizations but what if I just did PROM? Its still a manual technique rather than therex, which the patient does themselves. Ive never heard that you shouldnt bill PROM under manual therapy.
Also, what is prosthetic checkout vs prosthetic management? What does the checkout mean? Is that kind of like the initial examination for the fit of the prosthetic, and then if you were going to train them how to use it after examining it, then you would do training using management code?
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Physical Therapy Billing For Telehealth
While insurance reimbursement for telehealth services was primarily provided to medical doctors, there has been a dramatic rise in the reimbursement for virtual specialty services, including physical therapy. For physical therapists, offering virtual services can be a cost-effective way to expand your practice reach, retain clients and generate additional income for your business. Our patients and clients are becoming increasingly more interested in telehealth as time progresses, and it is important to consider offering telehealth within your practice. Healthieâs Free Starter Plan makes scheduling, offering, and billing for Telehealth appointments easy. To set up a free Starter account today, click here.
Within the United States, each state maintains its own jurisdiction with respect to the administration of telehealth services, including that by physical therapists. We recommend reviewing your state laws and regulations, as well as the guidance of your state practicing body, before implementing telehealth services in your care. Moreover, we recommend confirming with your liability insurance provider that your professional liability insurance covers telehealth services. You can read more on billing for telehealth here.
Common Billing Mistakes
â Billing to a Non-Billable Code
There are certain codes that will not be reimbursed if billed, specifically by Medicare and potentially a few other insurance companies. These include:
â Overusing or Using the Wrong Codes
Required Documentation Elements For A Low Physical Therapy Evaluation
There are two factors to consider when determining CPT Code 97161 Documentation Requirments.
1.) Look at the definition of the specific CPT code.
- Include 1-2 elements for the list provided.
- Determine the stability of the symptoms or condition.
- Determine the lack of complexity and lack of comorbidities.
2.) Understand the Medicare requirements for a physical therapy evaluation. Reference CMS Chapter 15 Section 220.3 Documentation Requirements for Therapy Services
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When Should I Use Modifier 59
Modifier 59 can monumentally impact your Medicare reimbursements, and unfortunately, its the modifier physical therapists struggle with most. Perhaps thats because the CPT Manual doesnt offer the most helpful guidance. Therefore, we recommend asking the following questions to decide if and when you should use modifier 59.
Improve Revenue Collection With Comprehensive Knowledge Of Coding Procedures
Current Procedural Terminology codes, more commonly called CPT codes, standardize medical tracking and billing for diagnostic, medical, and surgical procedures. Every task conducted by a health care practitioner has a unique five-digit number. Insurers review the submitted codes to determine the correct provider reimbursement for a patients visit.
CPT codes were created and copyrighted by the American Medical Association . The organization updates and maintains these codes as new treatments become available and older modalities become obsolete. Comprehensive knowledge of CPT codes and how they work can help physical therapists, speech-language pathologists, and occupational therapists ensure prompt, accurate billing for their services.
Currently, CPT codes fall into four main areas of classification:
- PLA codes: lab testing
- Category I: vaccines, medications, devices, services, treatments, and procedures
- Category II: quality of care and performance metrics
- Category III: procedures and services that use new modalities
Some CPT codes, commonly called bundled services, cover several different related procedures or treatments.
When the insurance company reviews the CPT codes for a patient visit, the company reimburses the provider based on the rates in the agreement with that practice. In other words, therapists from different practices do not necessarily receive the same insurance payments even when providing identical services.
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Selecting The Right Level Of Evaluation Complexity
Now, the million-dollar question for any therapy professional affected by these coding updates is: how does one go about selecting the appropriate level of complexity for each patient evaluation? Were glad you asked. Here are the four main evaluation complexity factors, along with a few sub-factors:
What Cpt Codes Are Used For Physical Therapy
Most of the CPT codes for physical therapy appear in the 97000 section, Physical Medicine and Rehabilitation, of the AMAs CPT code book. Codes can range from exercises performed for assessment to group activities to timed assessments or treatment.
Below is a small sampling of CPT codes that physical therapists may use to bill for services performed:
- 97012 Mechanical Traction
- 97161 PT Evaluation: Low Complexity
- 97162 PT Evaluation: Moderate Complexity
- 97163 PT Evaluation: High Complexity
- 97164 PT Re-Evaluation
- 97750 Physical Performance Test or Measurement
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Mckenzie Method Of Mechanical Diagnosis And Therapy
In a meta-analysis of randomized controlled trials , Machado et al evaluated the effectiveness of the McKenzie method for LBP. Medline, Embase, PEDro, and LILACS were searched up to August 2003. Two independent reviewers extracted the data and assessed methodological quality. Pooled effects were calculated among homogeneous trials using the random effects model. A sensitivity analysis excluded trials reporting on generic McKenzie. A total of 11 trials of mostly high quality were included. McKenzie reduced pain and disability at 1 week follow-up when compared with passive therapy for acute LBP. When McKenzie was compared with advice to stay active, a reduction in disability favored advice at 12 weeks of follow-up. Heterogeneity prevented pooling of studies on chronic LBP as well as pooling of studies included in the sensitivity analysis. The authors concluded that there is some evidence that the McKenzie method is more effective than passive therapy for acute LBP however, the magnitude of the difference suggested the absence of clinically worthwhile effects. They stated that there is limited evidence for the use of McKenzie method in chronic LBP and the effectiveness of classification-based McKenzie is yet to be established.
How Do You Bill For Occupational Therapy Telehealth Procedures
Occupational therapists can bill for telehealth procedures using an approved list of codes, which can be found on our OT telehealth cheat sheet. When appropriate, codes should include a modifier 95 to designate telehealth care and GO to designate services provided by an OT.
Additionally, condition code DR and modifier CR should be used when billing to Medicare during the public health emergency, as explained by CMS. For place of service, use the code for the place where the patient would have received in-person services, either home or clinic setting.
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The International Classification Of Diseases
In order to successfully bill for your services, youll need to diagnose your patients conditions in a manner that demonstrates the medical necessity of those servicesand youll need to do so using the latest version of the International Classification of Diseases , which, as of October 2015, is ICD-10. Given the complexity of the new coding system, it can be difficult to decide which codeor codesto use. However, you should select the most specific code that most accurately reflects the condition. See the most common ICD-10 codes used in PT here.
If youre ever in doubt as to whether your codes are reimbursable under your payers payment policy, call the payer before submitting the claim. According to the APTA, Your goal is to maximize the number of claims that are paid on the first submission and to minimize the need for appeals. In other words, in this case, its much better to ask for permission than for forgiveness.
Whats The Difference Between Cpt Codes And Icd
ICD-10, or the tenth revision to the International Classification of Diseases, is a diagnostic coding system created by the World Health Organization. The American Medical Association creates CPT codes, which represent procedures rather than diagnoses.
Lets use an example of a physical therapist seeing a patient with a dislocated shoulder. The therapist would notate the injury using the ICD-10 code S43 along with the appropriate sequence relevant to the encounter and injury location, like S43.003A .
However, to treat the patient, the therapist would notate the procedures performed using CPT codes. If they performed a moderately complex evaluation, theyd use CPT code 97162, along with any other procedure codes and modifiers relevant to the patients visit and services rendered.
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