In any Physical therapy practice, correct billing codes for physical therapy services are not simply confined to the accounting section. Still, they are critical for getting the practice back on track and providing clients with the highest standard of care.
You might be surprised that almost 30% of no-pay claims are rejected hospital bills due to a billing mistake. This has implications for revenue earning and delayed payments, increasing the chances of incurring losses.
Moreover, the payment proportion of physicians can increase to 15% when healthcare providers utilize correct standard billing codes.
Enhancing the accuracy of the issued invoices will minimize possible denials and related legal complexities, making it easier for physical therapists to provide their services to improve patients’ lives.
What are Billing Codes for Physical Therapy Services
Healthcare providers describe operative work, therapies, and services through medical billing codes they develop and understand. They facilitate accurate information sharing about patient care facts to healthcare providers, insurance companies, and other stakeholders. Billing codes for physical therapy are crucial for documentation and billing procedures and to facilitate healthcare provider reimbursement.
Billing codes for physical therapy services encompass initial exams, therapeutic exercises, manual treatment, and neuromuscular re-education. Service-specific codes enable precise billing. Evaluation codes vary by patient complexity and the services needed. This guarantees that the therapist is accurately represented and reimbursed for their time, effort, and resources.
There are two primary coding systems used in physical therapy billing:
1. Current Procedural Terminology (CPT) Codes
The American Medical Association (AMA) codes medical, surgical, and diagnostic services. Physical therapy often uses CPT codes to describe operations, including therapeutic exercises, manual therapy, and gait training. A unique five-digit CPT number for each procedure ensures accurate invoicing and identification.
2. Healthcare Common Procedure Coding System (HCPCS) Codes
Key Billing Codes For Physical Therapy Services
The billing process relies on physical therapy procedure codes to accurately reflect patient treatments. Standardized under the Current Procedural Terminology (CPT) system, these codes assist healthcare providers in consistently billing and documenting.
Some frequent physical therapy procedure codes:
97110 – Therapeutic Exercise: This code is used when a therapist introduces the exercises aimed at creating strength, endurance, ROM, and Flexibility by a therapist. It is frequently applied when the patient has injuries or after surgical procedures.
97112 – Neuromuscular Re-education: This code applies to activities aimed at improving balance, coordination, posture, and proprioception. It is often used for patients with neurological conditions.
97116 – Gait Training: This code is for walking and stair climbing patients, which is vital when the patient has had lower limb injuries or surgery.
97530 – Therapeutic Activities: This code uses dynamic activities to improve functional performance, such as lifting, reaching, or bending.
97035 – Ultrasound: This code is used for therapeutic ultrasound treatments. This treatment helps to reduce pain and improve tissue healing.
How These Codes Are Applied in Billing and Documentation
For physical therapy, reimbursement requires accurate documentation and coding. Therapists must record interventions, session duration, and patient response when recording treatments. This information aids in meeting service requirements and CPT code selection.
Each procedure code must match session services for billing. Therapists submit insurance claim forms using these codes. Correct code use ensures healthcare providers get paid accurately and prevents audits and insurance claims denials.
Healthcare practitioners must comprehend and accurately use outpatient billing codes for physical therapy services. It promotes correct invoicing, clinical documentation, and insurance communication, improving patient care and healthcare practice financial sustainability.
How Procedure Codes Impact Billing
Billing requires accurate procedure code selection. Incorrect service coding can result in billing problems, refused claims, and practice losses.
- Correct codes guarantee the practice receives proper reimbursement for services. It prevents underbilling and overbilling, which can cause financial issues.
- Accurate billing and healthcare compliance depend on proper coding. Audits, fines, and lawsuits can result from incorrect or fraudulent coding.
- Correct coding helps maintain clear and precise patient records, which is vital for coordinating care across healthcare providers. Multidisciplinary patients may benefit from this.
Procedure Code for Outpatient Physical Therapy
Patients who do not need overnight hospital stays receive outpatient physical therapy. Patients heal from injuries, surgeries, and chronic diseases using exercises, manual therapy, and other modalities in this therapy. Healthcare relies on outpatient physical therapy to increase mobility, reduce pain, and boost function.
Outpatient billing codes for physical therapy services are necessary for numerous reasons. First, these codes ensure insurance billing and reimbursement accuracy. Healthcare providers and payers can communicate clearly with each code representing a service or therapy.
Final Words!
Coded bills are significant in the procedure of physical therapy. Billing codes for physical therapy services help in the issue of correct bills, which assists in the issue of reimbursement and insurance.
To enhance precise billing, always choose the correct process codes to avoid attracting rejection or delay of your claims. Precision billing in physical therapy practices leads to an effective revenue cycle, reduced time spent on billing, and enhanced patient care.
Don’t hesitate to contact us for professional billing assistance, billing codes, or questions about physical therapy services. Professional billing help is available from Resilient MBS.
Our skilled team can assist you in overcoming medical billing issues to run your practice smoothly. Contact us today to see how we can help you enhance revenue cycle management and billing.
