Physical therapy billing and coding process play a vital role in your physical therapy practice as your financial health relies on it. However, learning to properly code is easier said than execute. Maximum claim denials occur due to inaccurate Physical therapy codes as there are plenty of codes associated with this practice.
However, you can still demystify the physical therapy coding by grasping the knowledge about commonly used codes and modifiers involved in physical therapy billing. Following are the basics of physical therapy billing guidelines, codes and modifiers that you need to use often in your physical therapy billing process-
Understand the basics of the physical therapy coding-
1) ICD-10 codes:
ICD-10 codes, referred to as the International Classification of Diseases, are the diagnosis codes that describe a patient’s condition or injury. These codes are assigned to provide specific information about the medical justification of the therapy services. For example, if you are providing therapy for a sprained ankle, you should assign ICD-10 code s93.4.
2) CPT codes:
CPT codes (Current Procedural Terminology) indicate the specific services or procedures performed during the therapy session. These codes provide comprehensive information about the exact therapy type and its duration. CPT codes play a vital role in ensuring accurate billing and maximized reimbursements.
To make your coding process error-free, you need to a clarity on frequently used CPT codes mentioned below-
1) Evaluation codes:
Physical therapy starts with an evaluation as it determines the exact stage for the treatment plan. Based on the nature of the evaluation, you should use one of the following evaluation codes-
- 97161: Physical therapy evaluation, low complexity
- 97162: Physical therapy evaluation, moderate complexity
- 97163: Physical therapy evaluation, high complexity
- 97164: Physical therapy re-evaluation
2) Treatment codes:
Based on the evaluation, physical therapists perform necessary services and treatments. Each service or procedure has its respective CPT code. Here are some of the frequently used treatment codes-
• 97110: therapeutic exercise
• 97112: Neuromuscular re-education
• 97116: Gait training
• 97140: Manual therapy
• 97530: Therapeutic activities
The CPT codes must be used with some modifiers to accurately bill the PT services provided. The modifiers are alpha numeric codes that you must put on the CPT codes for more information about the PT services offered. GP, 59, KX, GA and CQ are some of the modifiers highly used in PT.
Most outpatient physical therapy practices prefer to free themselves from all the tedium related to physical therapy billing and coding by outsourcing it to a third-party revenue cycle management firm that takes care of the entire revenue cycle management process,
If you are searching for a perfect physical therapy billing partner, Sunknowledge could be the one-stop destination. As a top RCM company, Sunknowledge has optimized physical therapy billing for hundreds of PTs nationwide. For more information about their complete billing solution, speak with one of their experts today.
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