Physical Therapy Billing Codes Challenges

Physical Therapy Billing Codes – Overcoming Coding Challenges

Physical therapy billing codes can be a challenge due to the different methods of treatment and varied reimbursement procedures of different insurance companies especially Medicare.  For the purpose of getting paid in a timely manner, here are some tips that can assist a private practice owner in overcoming coding challenges.

Document the necessity of procedures performed.  Medicare states that no payment shall be made for any physical therapy billing codes that are not reasonable and necessary for treatment of injury or illness.  One important tip to prevent claims denied due to lack of medical necessity is the proper education and training of physical therapy billing staff.  Most common reason for this denial is the use of inappropriate physical therapy billing codes which does not match with the diagnosis codes.

Include all assessment and required treatments or equipments in the physical therapy documentation.  Initial treatment includes evaluation and any need for equipment required for the patient’s fast recovery can be assessed as early as the initial evaluation.  Physical therapy billing codes should support the needs for such medical supplies like wheel chair or special shoes for diabetics.  Careful analysis of these codes should be done to make sure that the equipment will be covered by the insurance provider.

Use appropriate modifiers.  Using physical therapy billing codes modifiers can be used to make documentation and billing more accurate and more apt for the services or treatment performed to a physical therapy patient.  Medicare and other insurance providers have specific policies when it comes to using modifiers.  It is best to comply to avoid billing claims from getting denied.

Accurate reporting and scheduling of post operative treatments.  It is common for some medical conditions requiring surgical treatments to need rehabilitative physical therapy treatment after the surgical procedure.  Different physical therapy billing codes apply to different post operative treatments.  Scheduling post operative sessions with your patients should be timed and coded properly to avoid any audit risks.  Most insurance companies follow a 90-day global period wherein you can use certain physical therapy billing codes.  Beyond that point, some specific codes can no longer be used and the billing claims will surely be denied.

With enough education and training, the correct application of physical therapy billing codes when billing patients can be made simpler.  As a private practice owner, a physical therapist should make sure that his billing staff is always on top of things but being constantly updated to the changing billing codes and procedures.


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