Physical Therapy CPT Codes – Billing For Newbies

It is not uncommon for physical therapy clinics to hire billing staffers who have little or limited experience.  Choosing the correct physical therapy CPT codes to use for each patient and procedure might be a challenge at first but with constant practice and regular training, the staff will eventually become very familiar with the billing process.

The goal of any clinic or medical facility is to generate as much income as they can for profitability and growth.  With this in mind, it is imperative that all claims sent for reimbursement are clean and are paid at first billing.  This can easy by making sure that the physical therapy CPT codes used and documentation required are in order.

To understand the physical therapy CPT codes, all billing staff should be trained and should take the time to learn treatment protocols, modality terms, and also equipment and tools used.  Here is a review of service categories covered in CPT:

• Evaluations and/or re-evaluations:  Physical therapy CPT codes 97001 and 97002 are used for these procedures.  When a patient comes in initially, an evaluation is done to assess and document his or her medical history, level of functionality and if there is a need to order measures and tests.
• Modalities have their own sub categories.  For supervised modalities, physical therapy CPT codes 97010 – 97028 are used.  These modalities are services that are not timed.  Another category uses the physical therapy CPT codes 97032 – 97039 for services that are timed and billable for every 15 minute of procedure.
• Therapeutic procedures with physical therapy CPT codes 97110 – 97546 are also timed and with direct, constant contact with the patient.  Examples of services under this category are manual therapy and gait training.
• Physical therapy CPT codes 97597 – 97606 are for management of wound care.  These services deal with removing necrotic tissues from a patient’s body to aid in healing.  These also require direct contact and the codes used will depend on the debridement and wound size.
• Measurements and tests are usually part of an evaluation.  In cases wherein they are requested by employers or payers, they will use physical therapy CPT codes 97750 – 97755.
• For prosthetic and orthotic management, CPT codes used are 97760 – 97762.  These services are for providing patients with specialized training on how to use assisted tools like prosthetics and orthotics.

As a medical billing professional, there is a need to constant update one’s knowledge in billing guidelines and procedures.  From time to time, there will be challenges and keeping abreast with all the changes ensures timely and error free billing.