Wiki New to PT coding

fredcpc

Guru
Messages
185
Location
Hillsboro, OR
Best answers
0
If we need to code for various PT modalities, whirlpool, massage, etc. What modifiers do we use? And how do we bill for shorter increments, like 9 minutes.
 
The modalities come as 15 minute increments to be 1 unit the service must be documented to be at least 8 minutes. At 23 minutes it is 2 units. However the sum of the parts cannot be more that the whole. Mean if you have say 2 modalities and one is 8 minutes and the other is 10 minutes then you would want to bill each for 1 unit this would give 2 units total, however the total time involved is only 18 minutes which is not enough time for 2 units so one modality must be dropped from the claim.
 
new at PT

So we had a 15, 8, 10, and then 5 minutes for therapeutic exercises. Does that mean only two units? Also, a PTA did this under the supervision of a PT.
 
Yes that is correct. The 5 minute modality is not billable and cannot be counted, after that you have 33 mintes total which is 2 units so you can only bill for 2 modalities at 1 unit each.
 
PT coding

Good info. Thank you. So I have 15 min of whirlpool, that is billable. 10 minutes of icepacks, that is also billable. And 8 minutes of massage, but that is not billable. The 5 minutes is not billable in this case. So, I will bill 15 of whirl and another 15 for ice, and that is it. Do I need modifier with this CPT codes?
 
Debra,

Can you point me to documentation for the information you shared? I'd like to share with others in my office.

Thanks!
 
I did not save the link but it came from Medlearn Matters. I will see if I can pull it up again. I just copied the relevant parts I needed.
 
Here is what I cut and pasted from the Med Learn:
Do not report any service done less than 8 minutes!

8 minutes to 22 minutes is billed as 1 unit
23 minutes to 37 minutes is billed for 2 units
38 minutes to 52 minutes is billed for 3 units

Trick:

If two modalities are used on the same treatment day:

eg.:

97110 39 minutes (3units)
97112 23 minutes (2units)

total treatment time: 62 minutes (4 units of PT services)

Report: 97110 for 3 units; 97112 for 1 unit. Assign more units to the
PT service that took more time.

All timed services must be documented on the medical record of the
patient.
 
New to PT billing

So, can I put it all together here, a slightly different scenario...I have 15 min of whirlpool, 8 min of icepack, 10 min of therapeutic massage. This boils down to...

whirlpool 97022 1unit
Massage 97124 1unit

Tell if I am wrong, no mod 59. But don't I need a GP modifier?
 
Top