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Primary Care Coding Alert

Reader Question:

Base PT Code Choice on Modality

Published on Tue May 01, 2007

Question: If the FP administers 25 minutes of electrical stimulation physical therapy (PT) followed by 15 minutes of massage PT, how should I code the encounter? Should I select two different codes, or combine the PT times and report a single code? New Mexico Subscriber
Answer: There is an entire set of PT codes, grouped by PT method. You-ll report CPT codes for each type of PT in your encounter. On the claim, report 97032 x 2 (Application of a modality to one or more areas; electrical stimulation��'[manual], each 15 minutes) for the 25 minutes of electrical stimulation PT. report 97124 (Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement [stroking, compression, percussion]) for the massage PT. Follow the -eight-minute rule-: When compiling PT time, do not report a 15-minute unit of PT unless you have performed at least eight minutes of therapy. So in your scenario, if the FP performed 20 minutes of electrical stimulation PT instead of 25, you would report 97032 once instead of twice. Explanation: If the FP performs 20 minutes of PT, that means he has performed one full unit of 97032 and only five minutes of additional PT. Best bet: Don't code for two units of PT until you reach 23 minutes of therapy time
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