Guidelines for Physical Therapy Medical Billing

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• Guidelines for Physical Therapy Medical Billing
• Physical therapy billing uses a set of codes to
  describe health conditions and treatments. These
  codes come from two main systems ICD codes,
  which describe the patients condition, and CPT
  codes, which describe the treatments given by the
  therapist. The current code system is ICD-10,
  but a new set called ICD-11 will be standard in
  2025.
• These codes need to be updated regularly, and a
  digital solution makes it easier to keep up with
  the changes. ICD codes tell about the patients
  problem, while CPT codes tell about the
  treatments given. For instance, a pulled muscle
  gets an ICD code, and the rehab exercises get a
  CPT code.
• When creating a bill for physical therapy, you
  use both ICD and CPT codes. But with tens of
  thousands of codes, doing it manually is
  time-consuming and prone to mistakes. Mistakes
  mean the bill could be rejected, leading to a
  lengthy resubmission process.
• All of this affects how quickly you get paid for
  your work in physical therapy. A shorter payment
  cycle means a smoother flow of cash.
• Why PT Billing Is So Important?
• Proper coding and billing is crucial for
  therapists to be able to keep their doors open.
  When PT clinics struggle with billing workflows,
  it can seriously impact their operations
• Claim denials pile up from inaccurate coding,
  leading to major lost income. This hurts the
• clinics bottom line big time.
• In severe cases, improper physical therapy
  medical billing could even be seen as fraudulent,
  risking fines or disciplinary action.
• The grueling administrative burden of manual
  billing tasks eats up hours that therapists
  should be spending with patients.
• Ultimately, these kinds of billing snafus make it
  harder for your patients to access quality PT
  when they need it. So although billing might seem
  removed from clinical practice, it directly
  impacts care.
• How Does Physical Therapy Billing Work?
• At its core, physical therapy billing relies on
  standardized code sets to accurately capture
  diagnoses and services provided. Two main systems
  are at play
• ICD Codes The Why

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• PTs assign CPT codes that represent everything
  done during each visit. This paints a picture of
  the care delivered.
• Matching ICD diagnoses with CPT treatment codes
  essentially tells the story of why care is
  medically warranted. It provides justification so
  the clinic can be reimbursed for services.
  Billing documentation also establishes ongoing
  necessity for continued treatment. No wonder
  therapists have to be coding experts!
• How Billing Tech Impacts PT Practice?
• In many clinics, therapists still have to look up
  codes manually and complete physical therapy
  medical billing paperwork by hand. This eats up
  tons of time that should be spent treating
  patients.
• New digital solutions aim to automate parts of
  the cumbersome billing workflow
• Automated coding Software analyzes session
  notes then suggests appropriate billing codes.
  Huge time saver!
• Structured notes templates Standardized forms
  for session documentation make record-
• keeping way more efficient.
• Real-time claim screening Claims can be
  instantly checked for errors to prevent denials
  before submission.
• Data analytics Reporting provides visibility
  into trouble spots like reasons claims are being
• rejected. This allows for targeted process
  improvements.
• With less time wasted on billing, therapists can
  put more effort into delivering excellent,
  personalized care. And accurate coding means way
  fewer claims getting denied or delayedmaking
  life easier for your patients. Its a win-win.
• What Are Physical Therapy Billing Units?
• In the context of physical therapy, billing units
  refer to a measurement used in the billing and
  reimbursement process for healthcare services.
  Physical therapy services are often quantified
  and billed based on units, which are standardized
  increments of time or specific procedures.
• Here are a few common ways physical therapy
  billing units are used
• Time-Based Units Physical therapy sessions may
  be billed in units of time, typically in 15-
  minute increments. For example, a 30-minute
  session might be billed as two units.

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• 97110 Therapeutic exercises This code is used
  for individual or group therapeutic exercises to
  improve strength, range of motion, flexibility,
  and coordination.
• 97112 Neuromuscular reeducation This code is
  used for activities that focus on the
  restoration of functional movement patterns
  through the facilitation of normal movement or
• through the inhibition of abnormal movement
  patterns.
• 97116 Gait training (includes stair climbing)
  This code is used for activities that focus on
  improving a patients ability to walk and
  navigate various surfaces.
• 97140 Manual therapy techniques This code
  covers hands-on techniques, such as
• mobilization or manipulation of joints and soft
  tissues, to improve mobility and reduce pain.
• 97530 Therapeutic activities This code
  includes dynamic activities to improve functional
  performance, such as balance and coordination
  exercises.
• Its important to note that these codes may be
  subject to updates, and the specific code used
  can depend on the nature of the physical therapy
  service provided. Healthcare providers and
  billing staff should refer to the most recent
  version of the CPT codebook and any relevant
  updates or guidelines from relevant authorities.
• The Takeaway
• While billing and coding seems far removed from
  clinical practice, its a core part of running a
  thriving PT clinic. When billing goes smoothly,
  therapists can pour their energy into delivering
  the hands-on care and personal attention patients
  deserve.