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New to PT coding

  1. #1
    Default New to PT coding
    Medical Coding Books
    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.

  2. #2
    Location
    Columbia, MO
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    12,531
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default 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.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default 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?

  6. #6
    Location
    Columbus, OH
    Posts
    76
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    Debra,

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

    Thanks!
    Kathy Daniel, CPC, COSC

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Location
    Columbus, OH
    Posts
    76
    Default
    Great thanks!
    Kathy Daniel, CPC, COSC

  10. #10
    Default 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?

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