Results 1 to 9 of 9

New or Established EM Code for Physical Therapy?

  1. #1
    Default New or Established EM Code for Physical Therapy?
    Medical Coding Books
    I have a question re: new or established patient E&M coding. Typically in a M.D., D.C. or D.O. facility the AMA guidelines are clear & precise however with a Physical Therapy facility, the therapist are not "physicians". If a patient has been seen in this facility, within three years however their visit is due to a different injury are they considered a new patient or established? I believe the answer to be that it doesn't depend on the DX of the patient however if the patient was seen in this facility or not! Please help as I'd like to be coding & billing correctly. Thanks

  2. Default
    It may depend on the insurance of the patient. More specifically, if they are workers comp.

    I was in a meeting recently and she used a PT facility as an example and said there was a new w/c ruling that with any new injury (even if it's only 1 week apart), the patient is considered a new patient.

  3. #3
    Default No E/M for PT specialty

    If my trainer was right, she stated that PT specialist can't bill E/M but use 97001 or 97002 instead. I'm pretty new to the industry so I can't deny nor confirm if it's true.


    Tina, CPC-A

  4. Default
    That is correct- physical therapist do not bill evaluation and management codes.

  5. #5
    I have a physical therapy client and they do not use E/M codes.

  6. Default
    PT only uses 97001 if new patient/new dx-this is considered evaluation
    OT only uses 97003 if new patinet/nex dx-this is considered evaluation
    re-evals get done every four weeks for Medicare/W/comp and the codes are as follows:

    PT 97002
    PT 97004

    Hope this helps!

  7. #7
    Default 97002
    Do you have anything in writing on the 97002 that states you can only bill the re-eval every 4 weeks? Our physical therapist is billing 97001 for the intial evaluation, but we are unsure on the guidelines for the 97002. Anything will be a big help....

    Thank you,
    Kristen Richard, CPC
    Kristen Richard, CPC

  8. #8
    St. Cloud, MN
    Go to the wpsmedicare site and search for the PT policy, this is loaded with information. It is Medicare, but more companies are following their rules. Also, Medica and United Healthcare I have found to have great resources for policies. I do billing for Medical, Physical therapy and Chiropractic in our office and PT's do NOT bill any E&M, the 97001 (eval) and 97002 (re-eval) are their version of an E&M.

  9. #9
    Can you please send me the link. I am from Rhode Island and we use NHIC. Not sure what wpsmedicare website is. Also, I did pull some info on the CMS website, and for the 97002, it does not state anything about 4 weeks. I am just wondering how to utilize the 97002 and when we are able to bill for that.
    Kristen Richard, CPC

Similar Threads

  1. V codes and S code in physical therapy
    By in forum Diagnosis Coding
    Replies: 1
    Last Post: 09-30-2015, 05:31 AM
  2. physical therapy code
    By robi528 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 01-31-2014, 12:42 PM
  3. Physical therapy code
    By kumeena in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-26-2010, 09:59 AM
  4. Physical Therapy group code + other proc codes
    By wnabbefeld in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-02-2010, 06:42 AM
  5. Physical Therapy Code 781.2
    By sarahb in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-02-2008, 01:03 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?


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.