Chances are the physical therapists in your practice don’t know a lot about billing. They got into rehabilitation to help people, not learn about insurance billing. However, making sure your practice receives enough money for its services is essential to keep your clinic thriving. Here are a few things to keep in mind when billing for your services to help take the guesswork out of the process.

1. PROHEALTHCAREPRODUCTS.COM

2. Chances are the physical therapists in your practice don’t know a
lot about billing. They got into rehabilitation to help people, not
learn about insurancebilling.

3. However, making sure your practice receives enough money for
its services is essential to keep yourclinic thriving.
Here are a few things to
keep in mind when billing
for your services to help
take the guess work out of
the process.

4. LEARNING THE ICD CODESFOR PHYSICAL
THERAPYBILLING
When you want to bill for
services, you’ll need to have a
diagnosis that encapsulates
the medical necessity of
physical therapy for your
patient under the latest
version of the International
Classification of Diseases
code set (ICD-10).

5. It’s especially important to use this billing code at the
outset and have it reflect both the diagnosis and
currentcondition.
It’s recommended to choose the
code that closely matches your
patient’s condition based on an
objectiveevaluation.

6. CPT codes or Current Procedural Terminology were
developed by the American Medical Association to be
used to bill insurance companies in order for physical
therapy practices to receive reimbursement. It is this
framework that must be understood in order to bill
successfully.

7. The CPT codes more relevant to a physical therapy practice are
located in the Physical Medicine and Rehabilitation section
(97000’s).
Keep in mind, you may bill for
any code outside of this section
as long as you can legally
provide that service in your
state.
Another thing to remember is
that just because you bill for it,
doesn’t make it reimbursable by
thepayer.

8. THEFOLLOWINGCODESARE THEMOST
OFTENUSEDFOR PHYSICAL THERAPY:
 Evaluations (97161-97163for PTs)and reevaluations
(97164 for PTs)
 Supervised(un-timed)modalities(97010–97028)
 Constantattendance(one-on-one)modalities(97032–
97039)-thesecan be billedin 15 minuteincrements
 Therapeutic(one-on-one)procedures(97110–97546)
 Activewoundcaremanagement (97597–97606)
 Tests and measurements(97750–97755)
 Orthotic and prosthetic management(97760–97762)

9. BILLING
TERMINOLOGY
FOR PHYSICAL
THERAPY

10. In addition to the codes, there is some specific
terminologythatis importantto know and understand.

11. BELOW IS A LIST OF IMPORTANTTERMS:
TREATMENT:
Refersto all therapeuticservices.

12. SERVICE-BASED(SUPERVISEDOR UNTIMED)CPT
CODES:
These apply to actions like evaluations for supervised or applying cold
packs.Thistype of code can’t be billed in increments.

13. TIME-BASED (CONSTANT
ATTENDANCE) CPT CODES:
These Are The Codes That Allow
For Variable Billing In 15-minute
Increments. These Are For One-on-
one Services, Primarily Manual
TherapyOr Therapeutic Exercise.

14. EVALUATION/REEVALUATION:
This is mostly used for a patient’s initial evaluation which might include a
complete patient history as well as any tests (like manual muscle testing).This
is when the practitioner is able to determine the diagnosis. A re-evaluation
can also be usedif a patient’s conditionor functionalstatus changes.

15. PLANOF CARE:
A plan of care is necessary
documentation for some insurance
providers.
The practitioner develops the plan of
care based on the patient’s diagnosis,
physical condition and therapeutic
goals which will provide the
foundation for future treatment
sessions. The plan of care will be
based off of any physician referrals
for treatment.

16. INITIALCERTIFICATION:
The Initial certification is required by Medicare which states
practitioners must “approve or certify the plan of care via signature in
a timely manner (within 30 days of the evaluation).” Similar to the
plan of care, the initial certification covers the first 90 days of
treatment. Once the 90 days has past, patient’s must be re-certified
to continuetreatment.

17. Keep in mind, therapists must complete a progress report for
Medicare patients at minimumeverytenth visit.

18. DISCHARGE NOTE:
A discharge note is an important part of charting and is
completed at the end of treatment. This is also a necessary part
of Medicare documentation.