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Wiki Physical Therapy Billing-I have a new
- Thread starter thar1995
- Start date
physical theraphy billing
all PT charges are 97530 , 97003 for initial eval, and they are all billed by units 15 min increments.. OT is 97530-1 and 97001 for initial eval, there are other codes involved as well such as 97110, 97022, but 97530 is the therapeutic code for PT and OT
all PT charges are 97530 , 97003 for initial eval, and they are all billed by units 15 min increments.. OT is 97530-1 and 97001 for initial eval, there are other codes involved as well such as 97110, 97022, but 97530 is the therapeutic code for PT and OT
mitchellde
True Blue
In addition to the CPT codes the first listed dx code will be V57.x followed by the reason for rehab and if necessary a 905.x-908.x code for late effect.
blnord
Guest
Actually, for Physical Therapy 97001 is the eval code and for OT it is 97003. Most used codes are 97140, 97110 and 97530 for both PT and OT. Watch for 97110 Therapeutic "exercise" and 97530 therapeutic "activities" as they are very similar. Also, alot of therapists use 97014-E Stim which is an untimed code (for Medicare it is G0283).
V57.1 is a PT code (V57.21 is OT) but this code is considered a non specific code, I try to use it as a secondary and not a primary DX if the therapy is following a procedure.
V57.1 is a PT code (V57.21 is OT) but this code is considered a non specific code, I try to use it as a secondary and not a primary DX if the therapy is following a procedure.
Last edited:
blnord
Guest
Medicare is it's own mess and too lengthy to explain here, your best bet is to go on your MAC's site and download the PT billing guide as there are many, many guidelines you will need to know.
mitchellde
True Blue
Per coding guidelines V57.x codes are all first listed only allowed. The coding guidelines are required by HIPAA to be adhered to.
blnord
Guest
you are correct, I misspoke there, the point I was trying to make was referring specifically to PT (see bold):
V codes also are frequently assigned for aftercare following orthopedic or surgical procedures to support therapy services. These V codes cover situations "when the initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease.
The aftercare V code would not be used if treatment is directed at a current, acute disease or injury."
I didn't want the poster to think she should always use the V57.X code
V codes also are frequently assigned for aftercare following orthopedic or surgical procedures to support therapy services. These V codes cover situations "when the initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease.
The aftercare V code would not be used if treatment is directed at a current, acute disease or injury."
I didn't want the poster to think she should always use the V57.X code
mitchellde
True Blue
When the reason for the encounter is for rehabilitation, the appropriate first listed code is the V57.x So yes it is always the appropriate first listed code... they are not providing acute care nor after care to the injury they are providing rehab due to the late effects to restore the patient to functional status.
per coding guideline:
15. Admissions/Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis.
Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed
per coding guideline:
15. Admissions/Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence the appropriate V code from category V57, Care involving use of rehabilitation procedures, as the principal/first-listed diagnosis. The code for the condition for which the service is being performed should be reported as an additional diagnosis.
Only one code from category V57 is required. Code V57.89, Other specified rehabilitation procedures, should be assigned if more than one type of rehabilitation is performed during a single encounter. A procedure code should be reported to identify each type of rehabilitation therapy actually performed
blnord
Guest
This is our local MAC's guidline:
Diagnosis Coding
When billing for therapy services, include the ICD-9 code that identifies the medical condition necessitating the therapy. It is not necessary to use the V57.1-V57.89 codes as primary or subsequent codes. However, if providers do use them, they must also include the diagnosis code of the specific medical condition for which each therapy service was provided.
Bill the most relevant diagnosis. As always, when billing for therapy services, the ICD-9 code that best relates to the reason for the treatment shall be on the claim, unless there is a compelling reason. For example, when a patient with diabetes is being treated for gait training due to amputation, the preferred diagnosis is abnormality of gait (which characterizes the treatment). Where it is possible in accordance with State and local laws and the contractors Local Coverage Determinations, avoid using vague or general diagnoses. When a claim includes several types of services, or where the physician/NPP must supply the diagnosis, it may not be possible to use the most relevant therapy code in the primary position. In that case, the relevant code should, if possible, be on the claim in another position.
Codes representing the medical condition that caused the treatment are used when there is no code representing the treatment. Complicating conditions are preferably used in non-primary positions on the claim and are billed in the primary position only in the rare circumstance that there is no more relevant code.
Diagnosis Coding
When billing for therapy services, include the ICD-9 code that identifies the medical condition necessitating the therapy. It is not necessary to use the V57.1-V57.89 codes as primary or subsequent codes. However, if providers do use them, they must also include the diagnosis code of the specific medical condition for which each therapy service was provided.
Bill the most relevant diagnosis. As always, when billing for therapy services, the ICD-9 code that best relates to the reason for the treatment shall be on the claim, unless there is a compelling reason. For example, when a patient with diabetes is being treated for gait training due to amputation, the preferred diagnosis is abnormality of gait (which characterizes the treatment). Where it is possible in accordance with State and local laws and the contractors Local Coverage Determinations, avoid using vague or general diagnoses. When a claim includes several types of services, or where the physician/NPP must supply the diagnosis, it may not be possible to use the most relevant therapy code in the primary position. In that case, the relevant code should, if possible, be on the claim in another position.
Codes representing the medical condition that caused the treatment are used when there is no code representing the treatment. Complicating conditions are preferably used in non-primary positions on the claim and are billed in the primary position only in the rare circumstance that there is no more relevant code.
mitchellde
True Blue
I feel the HIPAA mandated coding guidelines over rides this. My opinion
blnord
Guest
Yes, I'm not sure, Medicare has a list of acceptable codes that meet medical necessity and can be billed and that code is not on it? I find it's best with Medicare if something is working not to change it.....all good information though for the poster....thanks