How To Bill Insurance For Physical Therapy?

You’ll need to add a diagnosis code that indicates the medical necessity of your services in order to appropriately bill for them. This code (or codes) will be from the ICD-10 code set, which is the most recent version of the International Classification of Diseases code set. The first-listed diagnosis code you select should reflect “the diagnosis, ailment, problem, or other cause for encounter/visit shown in the medical record to be principally responsible for the services delivered,” according to the American Physical Therapy Association (APTA). “List extra codes that explain any coexisting conditions,” you’ll want to do next. To put it another way, start with the principal diagnosis code and then add as many additional codes as you need to completely explain the patient’s condition.

You can always call your payer before submitting a claim to make sure the code you chose is reimbursable under their payment policy. “Your goal is to maximize the number of claims paid on the initial submission and to limit the need for appeals,” the APTA says. So, if you’re unsure, ask.

CPT

The Current Procedural Terminology (CPT) is “the most generally accepted medical terminology used to report medical operations and services under public and private health insurance programs,” according to the American Medical Association (AMA). “When billing most third parties for services…it is vital to use codes to describe the services that were given,” according to the APTA. Although CPT does not accurately describe physical therapist interventions, it does give a reasonable billing structure.”

The 97000s (“Physical Medicine and Rehabilitation”) contain the majority of the CPT codes that are important to rehab therapists. Clinicians, on the other hand, can bill any code as long as they can offer the service legally under state law. However, just because a provider can legally bill for a code doesn’t imply a payer will reimburse for it, according to the APTA.

Before submitting a claim, we recommend that PT billers become familiar with the following CPT categories:

Modalities for constant attendance (one-on-one) (9703297039) (billable in 15-minute increments)

How do you bill a physical therapist?

97010 Hot or Cold Packs: A modality is applied to one or more regions using hot or cold packs.
97012 Mechanical Traction: Mechanical traction is the application of a modality to one or more regions.
97014 Unattended Electrical Stimulation: Applying a modality to one or more regions; electrical stimulation (unattended)
97016 Vasopneumatic Device: A vasopneumatic device is a device that applies a modality to one or more regions.
97018 A paraffin bath is the application of a modality to one or more places.
97024 Diathermy is the application of a modality to one or more places; diathermy is the application of a modality to one or more locations (eg, microwave)
97028 Ultraviolet: When a modality is applied to one or more locations, it is called ultraviolet.
97032 Electrical Stimulation (Manual): Applying a modality to one or more regions; electrical stimulation (manual), every 15 minutes
97033 Iontophoresis: The application of a modality to one or more places; 15 minutes of iontophoresis
97034 Contrast Bath: Applying a modality to one or more regions; 15-minute contrast baths
97035 Ultrasound is a therapy that is applied to one or more regions every 15 minutes.
97036 Hubbard Tank: Using a modality in one or more locations; Hubbard tank, every 15 minutes
97110 Therapeutic Exercises: Therapeutic exercises to enhance strength and endurance, range of motion, and flexibility in one or more areas, each lasting 15 minutes. (A service geared at enhancing a single parameter, such as strength, ROM, or something else.)
97112 Neuromuscular Re-education: A 15-minute therapeutic process in which movement, balance, coordination, kinesthetic awareness, posture, and/or proprioception are re-educated for sitting and/or standing tasks.
97113 Water Therapy: 15-minute therapeutic procedure in one or more locations; aquatic therapy combined with therapeutic exercise
97124 Massage Therapeutic: 15-minute technique on one or more locations; massage with effleurage, petrissage, and/or tapotement (stroking, compression, percussion)
97140 Manual Therapy Techniques: One or more 15-minute sessions of skilled manual therapy techniques (mobilization, manual lymphatic drainage, manual traction). (PROM is not the same as manual therapy.)
97530 Dynamic exercises are used as a therapeutic activity to improve functional performance. Describes activities that combine several criteria (strength, range of motion, balance, etc.) to focus on and achieve functional activity.
97535 Self-Care/Home Management: Self-care/home management training (ADL and compensatory training, meal preparation, safety measures, and instructions on how to use assistive technology devices/adaptive equipment).
97542 Wheelchair Management: 15 minutes of wheelchair management (e.g., examination, fitting, and training).
97760 Orthotic Management: Upper extremity(s), lower extremity(s), and/or trunk orthotic management and training (including examination and fitting when not otherwise reported), each 15 minutes
97761 Prosthetic Management: Upper and/or lower extremity(s) prosthetic training, 15 minutes each
97762 Checkout for Orthotic/Prosthetic Use: Every 15 minutes, check out for orthotic/prosthetic use with an established patient.

What CPT codes can physical therapists bill?

When billing for physical therapy, there are a number of various codes that can be utilized; we’ll go over 13 of the most popular ones here. CPT codes 97001-97002 should no longer be used to bill for a physical therapy patient’s initial or re-evaluation as of 2017. Providers should now use one of three codes to determine the level of complexity a patient presents for first evaluations:

Re-evaluation of physical therapy established plan of care was replaced with 97164, which requires an examination and the presentation of a new revised plan of care.

In an outpatient setting, re-evaluation is required every 10th visit or 30 days, whichever comes first, for Medicare.

There are ten most regularly used codes for services normally given by physical therapists. Because the descriptions of these services are a little hazy, invoicing for physical therapy is a complicated procedure. The phrase is kept open-ended so that if the insurance company doesn’t believe the service was medically required, they can easily refuse your claim based on the CPT code you used.

97110 Therapeutic Exercise: Strengthening, range of motion, endurance, and flexibility exercises that require direct contact time with the patient.
97112 Movement, balance, posture, coordination, and kinesthetic sense are all re-educated through neuromuscular re-education.
97116 Gait Training: Sequencing and training with assistive devices in a modified weight-bearing position, as well as completing turns with good form.
Soft tissue mobilization, joint mobilization, manipulation, manual traction, muscular energy techniques, and manual lymphatic drainage are all examples of manual therapy.
97150 Group Therapy: In a land or aquatic context, the physical therapist performs a therapeutic procedure on two or more patients at the same time.
97530 Therapeutic Activities: Any dynamic activity aimed at enhancing functional performance.
97535 Self-Care/Home Management Training: This includes ADL training, compensating training, safety procedures/instructions, meal preparation, and the use of assistive technology devices or adapted equipment, among other things.
97750 A functional capacity evaluation is a type of physical performance test that determines the function of one or more body parts or measures an aspect of physical performance.
97761 Prosthetic Training: This service includes fitting and training in the use of prosthetic devices, as well as a device assessment.
97762 Checklist for Orthotic/Prosthetic Use: Includes an evaluation of a current orthotic or prosthetic device’s effectiveness as well as a recommendation for change.

Is documentation time billable for physical therapy?

There’s no disputing that documentation takes time. Even if you have an EMR system that automates the process, producing thorough, accurate, and compliance notes takes a lot of time and effort. Unfortunately, as Pauline Watts, MCSP, PT, and Danna D. Mullins, MHS, PT explain in this article, you won’t be compensated for your efforts “Under Medicare standards, documentation time is not considered billable time.” However, the word “key” is crucial “The article goes on to say that you may be able to give chargeable services while documenting in some situations. Take, for example, patient education, which includes any time spent on the subject “Watts and Mullins write, “discussing progress in therapy with the patient, including improvement in objective measurements and how they are progressing toward their goals.” “This documentation time can be included in the treatment time if we document this patient education information at the same time we provide it to the patient.” One important caveat: the patient must take an active role in the discussion. That is, he or she cannot simply sit and listen passively as you read or speak your notes aloud. “Obviously, not all documentation can be done this way, and not all patients are fit to involve in this teaching process,” Watts and Mullins add. “The practice of sharing information with patients has a number of really favorable results for patients.”

What are the most common physical therapy CPT codes?

The “Common CPT Codes and Their Usage” section has had the most changes, with expanded descriptions and other helpful additions.

While most of us got into our industry because we enjoy helping people, money still dictates our profession, just like it does in every other field.

The money we receive for our services is determined by the resource-based relative value scale (RBRVS), which considers the work done, the cost to the practice, as well as the liability and risk associated with delivering the services or procedures.

Now, I’m not sure about you, but while I was in physical therapy school, I didn’t learn anything about proper billing. As we begin our clinical affiliations and careers, this is one of the subjects we are supposed to discover on our own.

People will have varied ideas on what constitutes proper usage of these physical therapy CPT codes depending on the physical therapy setting in which you practice and the site in which you are located.

Can physical therapists Bill E M codes?

2. Physical therapy services can be billed using the CPT physical medicine and rehabilitation codes by physicians/NPPs, independent physical therapists, and independent occupational therapists. The proper E&M code should be reported by the physician/NPP for evaluations and re-evaluations.

Can physical therapy bill for self care?

As I have stated, patient education does not have its own CPT code. “You are to bill for the time spent teaching the patient and/or caregiver the exercise program or other education delivered under the CPT code that best defines what you are teaching them,” according to this Gawenda Seminars post. To put it another way, education time is included in the time spent by the therapist on the linked intervention and should be reported using the service code that most closely matches what was taught.

This is an example of how to teach a patient how to do an oblique abdominal sit-up. Assume you’re teaching a patient how to do an oblique abdominal sit-up to assist them strengthen and stretch their muscles. You can bill CPT 97110 in this case (therapeutic exercise). But imagine you’re demonstrating this exercise to a patient in order to stimulate dissociation movement between the thoracic and lumbar parts (and, as a result, improve proprioception). You can bill CPT 97112 in this situation (neuromuscular reeducation). Finally, imagine you’re demonstrating this exercise to a patient in order to help them enhance their functional ADL performance. You can bill CPT 97530 in this case (therapeutic activities). Finally, you can incorporate your education into the service with which it is most directly associated.

Education and Training for Patient Self-Management Codes

A PT may be able to report codes from the Education and Training for Patient Self-Management code series under certain circumstances. These codes are only for reporting self-management education and training for specific disorders such arthritis, COPD, and asthma. Use of these codes, according to the APTA, necessitates:

“The use of a systematic curriculum to teach patients/clients how to effectively self-manage their existing illnesses or disorders, or to prevent comorbidity.”

These codes can be used by non-physician healthcare providers to identify a typical curriculum for up to 30 minutes of education for a patient, caregiver, or family member. Individual patients should be coded 98960, groups of two to four patients should be coded 98961, and groups of five to eight patients should be coded 98962. Furthermore, the curriculum must meet the requirements of a physician society, the American Physical Therapy Association, or another authorized professional body. The curriculum must be evidence-based, and the therapist must be able to assess the patient’s development using an outcome assessment method. The curriculum can, however, be changed as needed by the provider.

While Medicare bundles these codes, and many other insurers have followed suit, not all insurers follow the same policy. So, before you use these codes, double-check the payer’s policy.

Other Education Codes

Despite the fact that some codes include the word “education” in their descriptions, payers frequently refuse to reimburse PTs for those codes. PTs should not use codes for supplying educational materials because they are typically packaged, and they should not be used to track unsupervised education time (e.g., the patient watching an instructional video).

KX Modifier

The therapy soft cap exceptions process includes the KX modifier. If you believe it is medically necessary for a patient who has already achieved the cap to continue therapy, you would use the KX modifier and describe your reasons for doing so.

GA Modifier

If you issue an ABN because you believe some services are not medically reasonable and essential, you must use the GA modifier to indicate that you have an ABN on file. (Please note that you should not use the KX modifier if you utilize the GA modifier.)

GY: This code indicates that you provided a non-covered service but did not have an ABN on file. (Because the service is not covered, the patient is essentially liable for expenses.)
GZ: You anticipate the service being denied since it isn’t medically essential, but you don’t have an ABN on file. (The patient is not responsible for payment in this scenario.)

GP Modifier

Despite the 2019 proposed rule’s proposal to change the therapy modifiers (GP, GO, and GN), CMS has chosen to leave them alone. As a result, physical therapists must continue to use the GP modifier on all claim lines for services rendered as part of a physical therapy plan of treatment. (This is also true for occupational and speech therapy treatment regimens.)

CQ Modifier

CMS said in its 2019 final rule that, starting in 2022, it will only reimburse 85 percent of services provided in whole or part by a rehab therapist assistant. As a result, starting in 2020, if a PTA provides at least 10% of a particular service, you must include the CQ modifier to the claim line for that service, informing Medicare of the assistant’s involvement. Payment reductions, on the other hand, will not begin for another two years.

What does “locum tenens mean?

In Latin, “locum tenens” means “placeholder.” It refers to a person who temporarily performs the duties of another in medical billing language. Most PTs, OTs, and SLPs cannot simply add a modification to the treatment claim to indicate that a replacement physician provided those services. “As of June 13, 2017, private practice physical therapistsProvider Specialty 65practicing in ‘non-metropolitan statistical areas, medically underserved areas (MUAs), and health professions shortage areas as defined by the US Department of Health and Human Services’ can take advantage of locum tenens arrangements,” as we explained here. Even if they meet the aforementioned criteria, locum tenens PTs can only charge Medicare for services rendered under the regular PT’s NPI if they are absent for a limited length of time due to vacation, disability, continuing education, or other reasons, and the following conditions are met:

The replacement PT is paid on a per diem or other time-based basis.
The usual physical therapist does not use locum tenens for more than 60 days in a row. (If the regular PT returns to work and needs to leave again, he or she can rehire the same locum tenens PT, and the 60-day period will start over.)
A modifier is used by the physical therapist to indicate that the services were performed by a locum tenens PT.

It’s also worth noting that in 2017, CMS determined that this type of arrangement would no longer be referred to as “It did not offer a new term for “locum tenens.” We’ve opted to keep using this statement until a better alternative becomes available for the purpose of clarity and consistency.

Providers who do not work in MUAs, HSPAs, or rural areas must deal with what is referred to as “the problem.” “By only hiring temporary employees, contractors, and travel physical therapists who are fully credentialed with the same insurance companies that provide benefits to their patients (especially important for Medicare), you can avoid the “bill as” problem. Hiring through a certified hiring agency with confirmed credentials is usually the best method to do it.

What is MPPR?

CMS started restricting payments to therapists in 2011 when they performed numerous therapeutic treatments on the same patient on the same day. The Multiple Procedure Payment Reduction policy is the name of this policy (MPPR). PTs, OTs, and SLPs witnessed a 20% reduction in practice expenses (PE) invoiced to Medicare for these “always covered” services during the early years of MPPR, from January 1, 2011 to March 31, 2013. Since April 2013, that number has risen substantially, with therapists now facing a 50% reduction in their PE while providing these treatments. Here are four important things to know about MPPR changes, as well as how to handle MPPR in your clinic.

What is the 8-Minute Rule?

The 8-Minute Rule establishes the maximum number of service units that therapists can bill to Medicare for a given treatment date. To be eligible for Medicare reimbursement for time-based codes, you must offer direct treatment for at least eight minutes, according to the rule. Everything you need to know about the 8-Minute Rule is right here.

How do I bill for co-treatment?

When therapists from different disciplines agree that they can better address a patient’s treatment goals and needs if they perform their individual treatments during a single session, co-therapy may be suitable. (Some examples can be found here.) Payers, on the other hand, have varied regulations for co-treatment depending on the type of coverage and the setting. We’ve included Medicare’s guidelines below; for commercial payers, verify your contracts and/or contact them directly to learn about their requirements.

Medicare Part A

In an inpatient rehab facility, acute care environment, home health setting, or skilled nursing facility, two therapists from different disciplines deliver various treatments to one patient at the same time, each therapist should charge his or her whole treatment session with that patient separately. “If an OT and a PT co-treat from 10:30 AM to 11:30 AM, and the OT works on toileting strategies while the PT simultaneously addresses safe transfers, both clinicians could bill for the entire hour, provided they show proof of providing separate treatments with separate end goals,” writes Meredith Castin, PT in this blog post. In all cases, however, the plan of care and documentation must support the need for co-treatmentand this requirement cannot be based on provider convenience, as we’ll discuss shortly. Furthermore, all providers must adhere to all federal, state, practice, and facility policies addressing modality, modalities, and student monitoring, as well as any other federal, state, practice, and facility policies.

Medicare Part B

Therapists who work in Medicare Part B-covered facilities and clinics, on the other hand, cannot bill separately for the same or different services performed to the same patient at the same time. As a result, therapists must limit total billing time to the session’s exact length. In other words, a therapist from one field may bill for the complete treatment or the service units may be divided by co-treating therapists from various disciplines. For situations in which a PT or OT co-treats with an SLP, ASHA recommends the following: “The SLP would bill for one untimed session since SLPs normally bill treatment codes that signify a session (rather than an amount of time) and because Medicare has no defined minimum/maximum session length.” The OT or PT would then bill “the occupational or physical therapy timed treatment codes.”

The Rules

The American Speech-Language-Hearing Association (ASHA), American Occupational Therapy Association (AOTA), and American Physical Therapy Association (APTA) developed joint guidelines for both Medicare Part A and Part B that state that therapists should only co-treat a patient when doing so directly benefits the patient, as we explained here. It is never a good idea for therapists to work together on a case “Convenience of scheduling.” It’s crucial to note, as Castin explained in the above-mentioned essay, that while “For safety considerations, therapists frequently choose to co-treat…having a second person on hand to act as a contact guard (i.e., to avoid falls) is insufficient to warrant charging for a second therapist’s services.” Regardless of the environment, co-treatment paperwork must clearly state the therapists’ reasons as well as the specific goals that each therapist is addressing. And one therapist’s documentation isn’t enough, even if that therapist is billing for the entire session. Instead, both therapists should record co-treatment sessions in sufficient detail to express the team’s goalsas well as how the patient is progressing as a result. It’s also a good idea to limit the number of therapeutic services provided during a single treatment session to two.

Modifiers 59 and XP

When patients get same-day services that constitute NCCI edit pairs, practices and facilities that provide both physical and occupational therapy to their patients may need to include modifier 59 or modifier XP to their claims. Modifier XP would be appropriate if, for example, “an OT takes over treatment in the middle of a PT session,” while modifier 59 would be appropriate if the payer doesn’t recognize X modifiers or if there’s another reason to provide “otherwise linked services that should, given the circumstances, be reimbursed separately,” according to Castin. For example, if a PT provides gait training (97116) and an OT provides therapeutic exercise, you would use modifier 59. (97530). As a result, you’re informing Medicare that the services97116 and 97530were done separately and differently from one another and, as a result, both should be reimbursed.

When should I bill for a re-evaluation?

If one of the following scenarios applies, you should only bill for a re-evaluation:

You see a dramatic improvement, decrease, or change in the patient’s condition or functional level that the plan of care did not predict (POC).
During treatment, you discover new clinical discoveries that are somewhat connected to the primary therapeutic disease (i.e., a new diagnosis to add to the POC).
The patient does not respond to the existing POC’s treatment, necessitating a change to the POC.
You’re treating a patient who has a chronic illness and doesn’t see you very often.

What constitutes billable time?

Billable time is, in most situations, the time spent treating a patient. There are a few major exclusions (for example, you cannot bill for monitoring). Learn more about when to bill and when not to bill in this blog post.

What is the CPT code for pelvic floor therapy?

For pelvic floor dysfunction and physical treatment, CPT90912 and CPT90913 might be reported. Physical therapy services are provided to help the pelvic floor regain its function. The service should be explicitly documented in the documents, such as “pelvic muscles exercise/therapy.” For billing purposes, the codes used section biofeedback training. These exercises are mostly for the treatment of urinary incontinence.

Avoiding reimbursement claim denials

Have your insurance companies been dismissing your requests for reimbursement? Making adjustments and resubmitting a reimbursement claim can be frustrating, complex, and time-consuming. If your claims are consistently refused, the CPT code and the documentation are the most likely culprits. It’s possible that the claim has been coded incorrectly, or that the documentation is incomplete.

Let’s look at the three most prevalent CPT codes for Physical Therapy and Occupational Therapy, as well as how to document them correctly for payment. Continue reading to learn more about CPT 97110: Therapeutic Procedure, CPT 97112: Therapeutic Procedure (stroke and non-stroke), and CPT 97530 Therapeutic Activities.

CPT 97110: Therapeutic Procedure

“Therapeutic exercises to enhance strength, endurance, range of motion, and flexibility,” according to CPT code 97110. It can affect one or more bodily parts and necessitates immediate contact with a competent healthcare practitioner. It’s billed in 15-minute increments, as are many CPTs, with the eight-minute rule applied as necessary1.

The eight-minute rule might help you figure out how many units of a time-based service you can charge Medicare for. To count for one complete unit, you must execute the service for at least eight minutes, according to the guideline.

When it comes to documenting CPT 97110, there are a few things to remember. You must indicate the body part(s) that were treated, as well as the muscles and/or joints that were treated. You must also include a list of the individual exercises that were completed. CPT 97110 activities, for example, include:

Active, resistive exercises (whether isometric, isokinetic, or isotonic) to improve muscle strength and endurance
stretching exercises to increase flexibility (indicate type of stretch such as active, ballistic, pre-contraction, etc.)
Exercises that promote cardio-pulmonary endurance include treadmill walking and upper-extremity ergometer use.

Explain the purpose of each exercise in terms of accomplishing a specific functional goal in your documentation. Therapeutic exercises are designed to improve a single criterion, such as range of motion or strength. These will eventually allow real-life movements like as ADLs to be performed. However, ADLs, job chores, sports tasks, and other similar activities fall under CPT 97530 Therapeutic Activities (more on that later).

Make sure to include information about the volume of exercise in your CPT 97110 report. This entails keeping track of the number of sets and repetitions, as well as the degree of resistance (weight, force, torque), and the length of time held in each position. You should also keep track of how you came up with the resistance.

A popular way is to use a percentage of the patient’s 1-rep max or maximum voluntary isometric contraction. Finally, add a description of the final feel, muscle stiffness, and other changes.

Of course, if you have superior measurement technology, the entire process can be expedited. The PrimusRS evaluates exercise volume and work automatically and generates easy-to-read reports with all the information you need, saving you time and ensuring better results for your customers and clinic.

CPT 97112: Therapeutic Procedure

“Neuromuscular reeducation of movement, balance, coordination, kinesthetic awareness, posture, and/or proprioception for sitting and/or standing tasks” is what CPT 97112 refers to. Therapeutic procedures, like therapeutic activities, apply to one or more body regions and necessitate direct contact with the appropriate provider1.

You must specify the body components treated (particular muscles, joints) as well as the precise exercises and activities performed when documenting CPT 97112. This could involve the following:

Movement, balance, coordination, kinesthetic sense, and/or postural neuromuscular reeducation

Provide details on the exercise volume, including sets and repetitions, work (if available), time length, and specific techniques employed, such as PNF, Feldenkrais, Bobath, and so on. Also take note of any equipment used, such as a BAPS board, dexterity tools, sensory training, or desensitization techniques.

Explain the purpose of the exercises in terms of achieving a specific functional goal once more. In other words, therapeutic exercises and/or activities are designed to improve specific aspects of the body, such as neuromuscular control, balance, kinesthetic awareness, proprioception, and posture.

CPT 97112 for non-stroke patients

CPT 97112 is most commonly used for stroke patients, although it can also be used for other patients. Although certain payers (more than others) may make things more complicated, the truth remains that neuromuscular disease is a vast range of illnesses.

CPT 97112 also covers motor neuron diseases, disorders of the motor nerve roots and peripheral nerves, neuromuscular transmission abnormalities, and muscle diseases, in addition to stroke. Some people don’t realize it, but CPT 97112 can be very useful in outpatient orthopedic rehab.

You can utilize manual signals to have a patient complete open-chain shoulder exercises with their eyes closed, for example. The scapulohumeral rhythm and position sense will be improved as a result of this operation.

Maintaining equilibrium while doing precise movements is another example. Pelvic tilt exercises are used to teach the appropriate alignment of the pelvis. Maintaining proper tilt while moving the lower extremities is a development of that exercise, as is maintaining proper tilt while standing/balancing on one leg.

CPT 97530 Therapeutic Activities

“Use of dynamic activities to promote functional performance,” according to CPT code 97530. Lifting, pushing, tugging, reaching, throwing, and other similar activities are examples.” This code also necessitates direct, one-on-one communication, which must be paid in 15-minute intervals. 1

This sort of treatment is designed to help people improve their functioning abilities. CPT 97530, for example, is for persons who have problems with a certain ADL or sport, or who have mobility, strength, balance, or coordination deficiencies. The

Bending, lifting, catching, pushing, pulling, throwing, crouching, and other functional movements are covered by therapeutic activities. Lifting a heavy object and placing it on the top shelf is an example of a therapeutic activity that is primarily used to strengthen the overhead shoulder.

Higher reimbursement with BTE

Both the PrimusRS and the Simulator II, for example, make dynamic actions like lifting, pushing, and pulling at different heights possible. With the PrimusRS, you can even replicate sports actions like throwing a baseball. Furthermore, these devices allow for the measurement of workout volume in terms of labor (force times distance), which is a far more accurate measurement than sets and reps.

Avoid denied claims

The material in the preceding documents is targeted at requirements based on the CPT code selected. Your claims could be refused for a variety of additional reasons. Because a complete explanation would be well beyond the scope of this essay, we’ll only stick to the fundamentals. You should be able to answer “Yes” to the following questions based on your evaluations:

Is there a set of valid, standardized outcome measurements for each deficit? Have you determined that the specified therapy interventions are medically necessary?

Documentation checklist

You must be proactive in your approach in order to have adequate paperwork. When examining your documents, use the following checklist:

Make a thorough assessment, ensuring that each issue is identified. Any deficiencies should be clearly identified.
To document progress or lack thereof, use valid, standardized outcome measures that are related to the deficit for which the intervention is intended.
Document the requirement for competent involvement, especially for therapeutic activity, because payers think that patients can be taught an exercise regimen and then execute it on their own.
Optum360° and the American Physical Therapy Association (APTA). Physical Therapist Coding and Payment Guide. Utah’s West Valley. 2018 Optum360°

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