Coding is a make-or-break factor that influences the financial well-being of a practice, job satisfaction of healthcare professionals, and level of care patients receive. When it comes to physical therapy, accurate CPT codes are the lifeline for proper billing and documentation. Recognizing the significance of medical billers in healthcare, we have developed a comprehensive guide that empowers physical therapists and organizations with a profound understanding of CPT billing codes for physical therapy.

CPT Codes for Physical Therapy

The American Medical Association (AMA) introduced the CPT coding system to standardize the reporting and documentation of medical, surgical, and diagnostic services. Being a diverse field that encompasses various interventions and techniques, a specific set of CPT codes for physical therapy is necessary to accurately represent the services it provides.

In addition to these general codes, there are also physical therapy CPT codes for specific interventions. These codes include;

With regard to evaluations and reevaluations, physical therapists use the following CPT codes;

Common ICD Codes in Physical Therapy

In terms of ICD-10 codes, here are some of the most common ones used in physical therapy;

1. M25.511 – Pain in right shoulder: Pain in the right shoulder joint or surrounding tissues
2. M25.512 – Pain in left shoulder: Pain in the left shoulder joint or surrounding tissues
3. M25.521 – Pain in right elbow: Pain in the right elbow joint or surrounding tissues
4. M25.522 – Pain in left elbow: Pain in the left elbow joint or surrounding tissues
5. M25.531 – Pain in right wrist: Pain in the right wrist joint or surrounding tissues.
6. M25.532 – Pain in left wrist: Pain in the left wrist joint or surrounding tissues.
7. M25.551 – Pain in right hip:Pain in the right hip joint or surrounding tissues.
8. M25.552 – Pain in left hip: Pain in the left hip joint or surrounding tissues.
9. M25.561 – Pain in right knee: Pain in the right knee joint or surrounding tissues.
10. M25.562 – Pain in left knee: Pain in the left knee joint or surrounding tissues.

Documentation Requirements & Strategies

Accurate documentation plays a crucial role in the billing and coding of physical therapy services. To achieve optimal level of accuracy, therapists should maintain comprehensive records that include the following:

1. Patient demographics, including name, date of birth, address, phone number, and insurance information.
2. Medical history, including the patient’s chief complaint, allergies, and history pertaining to surgeries, medications, and social.
3. Physical examination findings, including the patient’s range of motion, strength, muscle tone, sensation, and any other relevant findings.
4. Diagnosis and goals of care.
5. Treatment plan, including the specific interventions that will be used to achieve the patient’s goal of care.
6. Progress notes, documenting the patient’s current state in their treatment plan.
7. Outcomes, documenting the patient’s level of recovery after the completion of physical therapy treatment.

To ensure accurate and detailed documentation of the above, therapists should;

1. Document as soon as possible after each patient encounter. This will help in remembering the details of the session and avoid accidental omissions.
2. Be specific and objective in the documentation process. Avoid using subjective language or generalizations to minimize the likelihood of misinterpretation of data.
3. Document patient progress at each session. Doing so will help with the accurate tracking of the patient’s progress or lack thereof.
4. Review documents regularly. This will ensure therapists have access to complete and up-to-date patient information.

Physical Therapy Billing & Claims Submission

When it comes to billing for physical therapy services, submitting claims to insurance companies and other payers using the right CPT codes is essential. Billers and coders have a crucial role in ensuring all information is accurate, complete, and follows payer guidelines. Timely submission of claims is key to getting reimbursements quickly.

Appeals & Denials in Physical Therapy Billing

Sometimes, claims for physical therapy services may be denied for different reasons. In such cases, understanding the appeal process is important. Be prepared to provide additional documentation or clarification to support the claim and navigate the appeals process.

Latest Updates in Physical Therapy Billing & Coding

Physical therapy billing and coding is always changing. To stay on top of its changes, therapists must regularly check resources like the AMA and payer websites for the most recent information.

Creating an exhaustive list of all physical therapy CPT codes can be challenging, considering the vast number of options available and the frequent updates in the field. However, there are a few steps that therapists can take to access a comprehensive and current list of CPT codes:

1. Consult the American Medical Association (AMA) CPT Code Manual: This widely used and reliable resource provides an annual publication with a complete and up-to-date list of CPT codes. You can obtain a physical copy or subscribe online for easy access.
2. Seek assistance from a medical coder or billing specialist: If you’re a healthcare provider or part of a healthcare facility, consider enlisting the help of a remote billing and coding assistant like My Mountain Mover. Their services provide access to the latest CPT codes and aid in selecting the appropriate codes for specific services.
3. Use electronic medical record (EMR) or billing software: Many healthcare organizations utilize EMR or medical billing software that comes equipped with an updated database of CPT codes. These systems simplify the process of choosing the correct codes based on the services provided. My Mountain Mover’s team of virtual billing assistants is trained in the latest EMR software, ensuring seamless integration into your workflow.
4. Explore professional organizations: Look into professional organizations like the American Physical Therapy Association (APTA) for valuable resources and guidance on CPT coding specific to physical therapy services.

Remember, accurate billing and reimbursement require expertise in medical coding. To avoid errors and compliance issues, rely on up-to-date resources and consult experts like My Mountain Mover’s remote medical coders. Stay informed and committed to accuracy in the ever-evolving healthcare coding landscape.

To learn more about hiring medical virtual talent who can handle billing and coding tasks, schedule a 10-minute discovery call today.