It is important to understand the physical therapy billing codes in the treatment continuum to prevent billing errors and maximize revenue by increased collections and reimbursements from third party payers. As a first step in understanding the physical therapy billing codes, the biller must know the categories of physical therapy services in Current Procedural Terminology as follows:
Evaluations and re-evaluations—This category includes the assessment and physical therapy documentation of the medical history of the patient, level of function, specific tests, diagnosis, and prognosis. The CPT codes 97001 and 97002 are used by physical therapists for this category.
Modalities — Per CPT definition, modalities can be “any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical, or electric energy.” Examples are traction, ultrasound and whirlpool treatment. Modalities can either be supervised which uses CPT codes 97010–97028 and are not timed; or defined as constant attendance which uses the timed physical therapy billing codes 97032–97039 and billable in 15-minute increments.
Therapeutic procedures—These services use CPT codes 97110–97546 and are timed. They also require interacting directly with the patient. Examples of these therapeutic services are manual therapy, gait training, aquatic therapy and neuromuscular re-education
Active wound care management— This involves direct contact with the patients wherein healing is promoted by removing necrotic and devitalized tissue from the body. Physical therapy billing codes are determined by the size of the wound surface and type of debridement. CPT codes 97597–97606 are used for this category.
Tests and measurements—For special tests and assessment, insurance carriers require using the physical therapy billing codes 97750–97755.
The billing staff usually depends on the documentation of the clinician to determine the number of service units reported and ensure that the correct physical therapy billing codes are used procedure by procedure. Careful considerations must be taken when reporting timed services. 1 unit of timed services is between 8-22 minutes; 2 units are between 23-37 minutes, etc. All these are detailed in the Medicare guidelines for timed services.
Physical therapy billing codes are much more complicated now because of the number of procedures that has been added over the years. Updates and revisions are regularly being done to the physical therapy billing codes to keep abreast of the changes in the industry and in the medical field as a whole. With all its complexities, using physical therapy billing codes gets easier with constant use and repetition.