Crack the Code: Mastering Physical and Occupational Therapy Billing

👉 Mastering CPT Coding in Physical/Occupational Therapy:

In physical and occupational therapy, the precision in selecting and justifying CPT codes is paramount.

We need to choose the correct CPT codes for occupational therapy and physical therapy evaluation based on complexity and then the correct treatment CPT codes based on the intent of the exercise/activity.

👉 Choosing the Right CPT Code: The Role of Intent:

The intent of an exercise/activity is the cornerstone in deciding which treatment CPT code to utilize.

For instance, the act of performing sit-to-stands can be coded differently based on its therapeutic intent.

When the primary intent is to strengthen lower body muscles, it should be billed under therapeutic exercises (CPT code 97110).

Conversely, if the aim is to improve the patient's ability to perform transfers effectively, such as moving from sitting to standing, it should be documented under therapeutic activities (CPT code 97530).

👉 Justifying Time and Units:

Documentation plays a critical role in justifying the amount of time and the number of units billed for each CPT code.

Physical and occupational therapists must show that what they did during the treatment session justifies the number of units or time they are billing for.

For instance, if a PT or OT bills two units of TEs the documentation must reflect enough therapeutic exercises to justify the allocated time.

If the number of exercises/activities does not seem to justify the number of units billed then you must explain why in your documentation. Did you spend time on education? Compensatory strategies? Providing increased time for a cognitive decline?

👉 Utilizing a Range of CPT Codes:

Physical and occupational therapy thrives on personalized treatment plans that promote adaptive responses, enhance sensory processing, and improve functional performance and safety procedures. In doing so we use a variety of CPT codes.

👉 The following CPT codes are used most frequently...

Therapeutic Exercise (CPT code 97110): These are used to improve strength, range of motion, and endurance. When creating a treatment plan, if the goal is to enhance muscle performance, therapeutic exercises would be a key component. Documenting these sessions involves detailing the exercises, repetitions, and any modifications made to meet the patient's unique needs.

Therapeutic Activities (CPT code 97530): These activities are directed at improving functional performance for daily living tasks. When sit-to-stands are performed to enhance transfer skills, for example, they're billed under this code. The documentation should reflect the functional nature of these activities and their relevance to the patient's daily life.

Manual Therapy (CPT code 97140): Techniques such as mobilization/manipulation, manual lymphatic drainage, and manual traction are included under this code. The choice of manual therapy techniques depends on the patient's clinical presentation and the therapist's assessment of what will best address the patient's limitations.

Neuromuscular Reeducation (CPT code 97112): This is aimed at restoring balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities. Documentation should highlight the deficits being addressed and the expected outcomes.

👉 Importance of Documentation

Along with providing sufficient documentation to justify the CPT codes and the number of units billed the documentation should also reflect the direct patient contact time, emphasizing the therapist's active engagement in guiding, instructing, and monitoring the patient's performance throughout the exercises.

This includes any modifications made to the exercises in response to the patient's performance and any rest periods necessary for the patient's safety and well-being.

At The Note Ninjas, our goal is to help other therapists with engaging patient-centered activities and documentation!

In The Note Ninja Membership, we go into much more detail on CPT codes and we have documentation templates to help you streamline your documentation and provide the best patient-centered care.

00:00 CPT Codes and Billing for PT and OT
00:20 Billing Is Based on Intent
00:31 Billing Therapeutic Exercise vs Therapeutic Activities
00:55 Billing Self-Care, Therapeutic Exercise, Neuromuscular Re-education