Results 1 to 5 of 5

Physical therapy coding

  1. #1
    Post Physical therapy coding
    Medical Coding Books
    In the Ingenix book, Coding for the Physical Therapist (Coding and Payment Guide), a Coding Tip is provided which states, "..According to CMS guidelines, at least 8 minutes of direct contact with the patient msut be provided for a single unit of service to be appropriately billed."

    One of our Physical Therapists has coded a 97140 (Manual Therapy, each 15 unit), but has documented in his progress note that he only spent 5 minutes on this. I am wondering if this can be billed at all, since the above does state that an increment must be at least 8 minutes. When I spoke to another therapist, THEY said not everyone has to adhere to those specific guidelines.. Only FEDERALLY FUNDED insurances will enforce those guidelines she said.. (e.g., Medicare, Medicaid).

    I was surprised with that response because I know all the other payers use the CPT guidelines for our regular Orthopedic codes. For instance, BCBS or MVP etc.. they all follow the same CMS guidelines on our E/M codes that are in the CPT books, etc.

    I've never coded P.T. before.. Anyone out there who can steer me in the right direction?

  2. #2
    Location
    Columbia, MO
    Posts
    12,836
    Default
    I have no idea what she is referring to. When you have a timed service, inorder to bill for a unit you must have a minimum of 1/2 of the required time documented so in the case of a 15 minute service it is rounded up to 8 min. This is not a Medicare policy you are correct it is the way the AMA wrote the procedure and the book.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Maryville
    Posts
    24
    Default
    agree this is a CPT guideline not Medicare

  4. #4
    Default Physical therapy coding
    Was this the only service the PT performed?
    Yoli

  5. #5
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by mitchellde View Post
    I have no idea what she is referring to. When you have a timed service, inorder to bill for a unit you must have a minimum of 1/2 of the required time documented so in the case of a 15 minute service it is rounded up to 8 min. This is not a Medicare policy you are correct it is the way the AMA wrote the procedure and the book.
    Completely agree. Show the therapist the "Time" heading in the Intro at the beginning of the CPT book as proof.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

Similar Threads

  1. Please help Physical Therapy Coding
    By tlewis76 in forum Medical Coding General Discussion
    Replies: 12
    Last Post: 03-31-2014, 05:27 PM
  2. Physical therapy coding
    By mconnolly in forum Billing/Reimbursement
    Replies: 0
    Last Post: 02-27-2014, 11:05 AM
  3. ? physical therapy coding
    By leeo in forum Diagnosis Coding
    Replies: 1
    Last Post: 08-04-2008, 01:10 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.