Physical Therapy Billing Codes – A Guide To ICD-10 Codes

Due to the limitations of the ICD-9 coding system, the World Health Organization has published the ICD-10 codes.  These, which includes physical therapy billing codes, seeks to define diseases, symptoms, signs, complaints, abnormal findings, any external causes of disease or injury and social circumstances.  In the United States, it is the National Center for Health Statistics (NCHS) who came up with the ICD-10-CM which will replace the ICD-9-CM codes.

The ICD-9 codes were replaced due to a number of limitations that affects all medical billing codes including physical therapy billing codes.  It was found out that the ICD-9 codes contains terminology that is considered outdated and is no longer consistent with today’s medical practice.  The codes has insufficient details and specificity in differentiating severity and risk, lacks accuracy in anatomical descriptions and does not support optimization of claim reimbursement.

Aside from those stated above, the old ICD-9 codes for physical therapy billing codes failed in capturing detailed data for health care analysis.  It also does not provide enough detail that would allow for further streamlining of the automated claims processing.  Having this capability will result in lesser denials and delays in payment of claims.

There is a list of the perceived benefits for therapists in using the new ICD-10 physical therapy billing codes. It will improve the operational processes not just for physical therapy but for the entire health care industry.   It will now allow for more detailed classification within physical therapy billing codes that would lead to more accuracy in processing payments and reimbursements.

The diseases classifications and terminology will be updated to make it consistent and relevant to the current medical practices and advances.  In using the new ICD-10 physical therapy billing codes, it will enhance accuracy in coding and in specificity to the classification of anatomic sites.

In terms of fraud prevention, the new physical therapy billing codes will provide payers and oversight government agencies to more effective detect and investigate potential fraud and or abuse.

The implementation of the new physical therapy billing codes is divided into small and medium practices.  A small practice is defined to have up to five medical practitioners while a medium one should have at least 6 and a maximum of 20 medical professionals in one facility.

The implementation of the ICD-10 is broken down into steps for easier transition.  For therapists, the process of transitioning to the new physical therapy billing codes includes the following:

  • Creating a timeline and plan for implementation
  • Conducting evaluations with vendors
  • Both internal and external communication activities
  • Identification and assessment of training needs
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