PT Billing Basics: The Coding Systems Every Physical Therapist Should Know

In physical therapy the primary concern is treating the patient, and rightly so.

But while it may not be the most important aspect of the job, getting paid should come at a very close second since it’s the only way by which a practice can continue.

Getting paid however means acquiring a whole different set of skills and knowledge that revolve around codes and coding. For those still establishing their practice and even for some veterans, the task of coding can be confusing and even overwhelming at times. It takes some time, practice and diligence to do so without over- or under-coding and other such errors.

A good place to start would be knowing the coding systems you need to use. Getting a good grasp on the coding systems is the firm foundation by which physical therapy coding and billing can be done right.

The Coding Systems

There are two coding systems that every physical therapist should know and use. The first is the International Classification of Diseases, or the ICD.

The ICD is maintained by the World Health Organization (WHO) and is defined as the “standard diagnostic tool for epidemiology, health management and clinical purposes”. It serves to most accurately describe a patient’s diagnosis and the necessity of the treatment given, and is revised periodically in order to do so. Currently, the latest version in use is the ICD-10.

Choosing the right codes from the ICD-10 can be a challenge. The trick, according to the American Physical Therapy Association is to find the code or codes that most accurately describe the condition that you are treating based on objective evidence. While it may seem more convenient, don’t rely too much on your most commonly used codes as this can result in under- or overcoding. If you’re unsure about whether or not a particular code is reimbursable, check the payer’s payment policy first or better yet, call the payer before submitting the claim to be sure.

The second coding system you need to be familiar with is the Current Procedural Terminology or CPT.

The CPT describes the services given to the patient, and is maintained by the American Medical Association (AMA). Right off the bat you may be wondering, “what is the difference between the CPT and the ICD ?”, and the answer is quite simple. The ICD focuses on the diagnosis of the patient; the illnesses for which the patient requires treatment. The CPT on the other hand, focuses on the procedures given to treat the patient, for which the patient can be billed.

Most of the CPT codes that are relevant to physical therapists can be found in the Physical Medicine and Rehabilitation section of the CPT, but any of the other codes can be used as long as they accurately represent the service you provide and that you provide that service legally. Take note however, that just because it is legal doesn’t mean you can be reimbursed for it. As with ICD codes, if you’re not sure it is reimbursable it’s best to contact the payer and ask.

The CPT is updated annually, on the month of October. It’s important for therapists to always keep themselves updated on the latest editions so as to use the right codes and avoid costly claim denials. You can do this by frequently checking the WHO and AMA websites, or you can also get the latest updates from Park Medical Billing.

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