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Physical Therapy Billing

  1. #1
    Default Physical Therapy Billing
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    Doctor's order states PT for abnormal gait and Parkinsons. During the initial assessment by the therapist, they determine there is pain in the knee, pain in the heel and are now treating the patient with iontophoresis for the pain. We have received a denial for the iontophoresis because abnormal gait and Parkinsons are the codes on the bill. My question is, when the therapist uncovers further "diagnoses" on their assessment, can I add them to the bill as secondarys? My feeling is no. Eventually the physician signs this PT note for the record, but the doctor did not diagnose pain, therefore it did not get picked up. Advice? This is an outpatient physical therapy claim in my hospital and the physician is a community physician not associated with our hospital.

  2. #2
    Columbia, MO
    essentially you do have two problems here.. first you have a referral from the provider for rehab, which is coded with the V57.1 first listed for rehab claims. As far as your therapist diagnosing pain and then treating it without a physician referral for it depends on the payer. But it is best to separate your rehab encounters from your pain control encounters. Pain control/management is coded with the appropriate 338.xx code first listed and then the cause of the pain or location of the pain secondary, look in your coding guidelines for all this information. Then check with the payer as to whether you are required to have a new referral upon the therapist finding a new problem.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thank you. Yes, I did code the V57.1 first then 781.2 and 332.0. The payer is Medicare.

  4. #4
    There are only certain codes that Medicare will cove for this procedure and I do not have my list with me but I do not believe any of the ones above mentioned are good for Medicare. We have to have them sign an ABN because if it has to do with feet or knees it is not covered. I believe it covers it on the shoulder. I will send you codes tomorrow when I get to work and look at my list. You maybe able to go to Medicare website and look it up also.

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