Having an adequate billing system in place is essential in having a successful physical therapy practice. In 2018, changes to the medical coding system are continuous and with the upcoming evolution towards ICD-10, many physical therapy practices need to have the knowledge and education to understand and implement these new requirements in order to get paid for services. When your practice makes mistakes in coding, it can result in delayed or denied claims. Not only that, but it takes time, money and education to adequately maintain a billing department in-house to help optimize your physical therapy practice’s profits.

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2. Having an adequate billing system in place is essential in
having a successful physical therapy practice.
In 2018, changes to the medical coding system are continuous and
with the upcoming evolution towards ICD-10, many physical therapy
practices need to have the knowledge and education to understand
and implement these new requirements in order to get paid for
services.

3. When your practice makes mistakes in coding, it
can result in delayed or denied claims.
Not only that, but it takes time, money and
education to adequately maintain a billing
department in-house to help optimize your
physicaltherapy practice’s profits.

4. In this post, we’ll discuss some of the basic terminology
your practice should be familiar with when billing and the
most popular CPT codes being used to successfully bill
for services today.

6. Let’s outline some of the common billing terminology. This is
useful in order to understand how to effectively use physical
therapy CPT codes as well as communicate with your biller,
when necessary.

7. This is separate from timed treatment. For example, if you plan to bill for a 60-
minute session and you will use an untimed code for 15 minutes of the session.
You would only bill for the remaining 45 minutesusing a different code.

8. When an untimed code is used, there is a predetermined fee for the session,
regardless of the type of treatment, modality or the number of areas of the body
being treated.
UNTIMED CODES:
This type of code can only be used
once for an individual treatment
and must not be included as part
of billing calculations for timed
treatment.

9. TIMED CODES:
Timed codes are exactly what they sound like,
these are billing codes that are used to bill
for the actual time a practitioner spends with
a patient as well as time for skilled
interventions.

10. These codes include time for pre-treatment, actual treatment and post-
treatment.
For example, if you plan to use this code for a 30-minute treatment
session, you could bill for the entire session underthis code.

11. Assessment and case management are a necessary part of some
physical therapy sessions.
PRE-TREATMENT TIME:
Physical therapists can bill for this time to assess patient
progress, evaluate for injury or muscle deficits or analyzing the
what approach will be taken during a treatment session under the
purview of pre-treatment.

12. Includes assessment and management, assessing patient progress, inspection
of the tissue or body part, analyzing results of the previous treatment, asking
questions, and using clinical judgment to establish the day’streatment.
This can all be billed as contact
time from the physical therapist or
aide. With this code, if you spend
20 minutes performing manual
muscle testing using a handheld
dynamometer, this would be billed
underpre-treatment time.

13. INTRA-TREATMENT TIME:
This code refers to any time spent providing an intervention.

14. POST-TREATMENT TIME:
Some time is spent each session
analyzing a patient’s response to
either an intervention, treatment or
giving education or home exercise
program.
Post-treatment time can also
include time spent documenting in
the patient’s chart and/or
consulting with other healthcare
professionals about the patient’s
care.

15. The only caveat to this rule is that
the patient must be present when
these events occur in order to use
this code.
For example, if you spend 10
minutes explaining how to do
exercises for the patient’s home
exercise program, this could be
billed aspost-treatment time.

16. The 8-Minute Rule: The 8-minute rule is an important one to
understand, because according to American Medical Association
(AMA) guidelines, leftover minutes that fall into multiple categories
with less than 8 minutesper category cannotbe billed for.
For example, if you spend 6 minutes providing manual therapy and
5 minutes providing ultrasound therapy.

17. The codes must be totaled and billed for the treatment with the greater treatment
time. This also works according to Medicare guidelines (8-Minute Rule), where you
can combine this extra time (11 minutes total) into one additional unit of manual
therapy since the sum of your remainders was more than 8 minutes (you bill for the
service that youprovided more of, hence, manual therapy in this case)

18. Medicare 8-Minute Rule:
1 unitof treatment time = 8-22 minutes
2 unitsof treatment time = 23-37 minutes
3 unitsof treatment time = 38-52 minutes
4 unitsof treatment time = 53-67 minutes
5 unitsof treatment time = 68-82 minutes
6 unitsof treatment time = > 83 minutes

19. The Most Common CPT Codesin PhysicalTherapy
The most common CPT codes billedby physical therapists fall into
two categories:
 Therapeutic exercise (CPT 97110)
 Manual therapy (CPT 97140).

20. COMPREHENSIVE LIST
OF CPT CODES TO
KNOW AS WELL AS
THEIR DESCRIPTIONS:

21. • 97001 Physical Therapy Evaluation
• 97002 Physical Therapy Re-evaluation
• 97010 Hot or Cold Packs: Application of a
modality to one or more areas; hot or
cold packs
• 97012 Mechanical Traction: Application
of a modality to one or more areas;
traction, mechanical
• 97014 Electrical Stimulation
(unattended): Application of a modality to
one or more areas; electrical stimulation
(unattended)

22. • 97016 Vasopneumatic Device: Application
of a modality to one or more areas;
vasopneumatic devices
• 97018 Paraffin bath: Application of a
modality to one or more areas; paraffin
bath
• 97022 Whirlpool: Application of a modality
to one or more areas; whirlpool
• 97024 Diathermy: Application of a modality
to one or more areas; diathermy (eg,
microwave)
• 97026 Infrared: Application of a modality
to one or more areas; infrared

23. • 97028 Ultraviolet: Application of a modality to one or more areas; ultraviolet
• 97032 Electrical Stimulation (manual): Application of a modality to one or more areas;
electrical stimulation (manual), each 15 minutes
• 97033 Iontophoresis: Application of a modality to one or more areas; iontophoresis,
each 15 minutes
• 97034 Contrast Bath: Application of a modality to one or more areas; contrast baths,
each 15 minutes

24. 97036 Hubbard Tank: Application of a modality to one or more areas; Hubbard tank, each
15 minutes
97110 Therapeutic Exercise: Therapeutic procedure, one or more areas, each 15 minutes;
therapeutic exercises to develop strength and endurance, range of motion, and flexibility.
(Generally describes a service aimed at improving a single parameter, such as strength,
ROM, etc.)
97112 Neuromuscular Re-education: Therapeutic procedure, one or more areas, each 15
minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense,
posture, and/or proprioception for sitting and/or standing activities
97113 Aquatic Therapy: Therapeutic procedure, one or more areas, each 15 minutes;
aquatic therapy with therapeutic exercise

25. 97116 Gait Training: Skilled improvement of gait,
includes stair climbing
97124 Massage Therapeutic: procedure, one or
more areas, each 15 minutes; massage, including
effleurage, petrissage and/or tapotement
(stroking, compression, percussion)
97140 Manual Therapy Techniques: Skilled
manual therapy techniques (mobilization, manual
lymphatic drainage, manual traction), one or more
regions, each 15 minutes. ( PROM is NOT manual
therapy)
97530 Therapeutic Activity: Use of dynamic
activities to improve functional performance.
Describes the activities that use multiple
parameters (strength, ROM, balance, etc) together
and focus and achieving functional activity.

26. 97535 Self Care / Home Management: Self care/home
management training (ADL and compensatory training,
meal preparation, safety procedures and instructions in
the use of assistive technology devices/adaptive
equipment)
97542 Wheelchair Management: Wheelchair
Management (eg, assessment, fitting, training), each 15
minutes
97760 Orthotic Management: Orthotic(s) management
and training (including assessment and fitting when not
otherwise reported), upper extremity(s), lower
extremity(s) and/or trunk, each 15 minutes
97761 Prosthetic Management: Prosthetic training,
upper and/or lower extremity(s), each 15 minutes

27. • 97762 Orthotic/Prosthetic Checkout: Checkout for orthotic/prosthetic use, established
patient, each 15 minutes
• 97150 Group Therapeutic: procedure(s), group (2 or more individuals)
• 29530 Knee Strapping
• 29540 Ankle Strapping
• 29240 Shoulder Strapping