Specialty Physical Therapy Billing Company

Guidelines for Physical Therapy Medical Billing

Physical therapy billing uses a set of codes to describe health conditions and treatments. These codes come from two main systems: ICD codes, which describe the patient’s condition, and CPT codes, which describe the treatments given by the therapist. The current code system is ICD-10, but a new set called ICD-11 will be standard in 2025.


These codes need to be updated regularly, and a digital solution makes it easier to keep up with the changes. ICD codes tell about the patient’s problem, while CPT codes tell about the treatments given. For instance, a pulled muscle gets an ICD code, and the rehab exercises get a CPT code.


When creating a bill for physical therapy, you use both ICD and CPT codes. But with tens of thousands of codes, doing it manually is time-consuming and prone to mistakes. Mistakes mean the bill could be rejected, leading to a lengthy resubmission process.

All of this affects how quickly you get paid for your work in physical therapy. A shorter payment cycle means a smoother flow of cash.

Why PT Billing Is So Important?

Proper coding and billing is crucial for therapists to be able to keep their doors open. When PT clinics struggle with billing workflows, it can seriously impact their operations:

  • Claim denials pile up from inaccurate coding, leading to major lost income. This hurts the clinic’s bottom line big time.
  • In severe cases, improper physical therapy medical billing could even be seen as fraudulent, risking fines or disciplinary action.
  • The grueling administrative burden of manual billing tasks eats up hours that therapists should be spending with patients.

Ultimately, these kinds of billing snafus make it harder for your patients to access quality PT when they need it. So although billing might seem removed from clinical practice, it directly impacts care.


How Does Physical Therapy Billing Work?

At its core, physical therapy billing relies on standardized code sets to accurately capture diagnoses and services provided. Two main systems are at play:


ICD Codes – The “Why”

  • ICD stands for International Classification of Disease. These codes define a patient’s medical diagnosis like knee osteoarthritis or lumbar disc herniation.
  • Your referral includes the appropriate ICD code for the condition being treated. This establishes medical necessity so insurance will cover therapy.

CPT Codes – The “What”

  • CPT is short for Current Procedural Terminology. These codes describe specific interventions like therapeutic exercise, manual therapy, or gait training.
  • PTs assign CPT codes that represent everything done during each visit. This paints a picture of the care delivered.

Matching ICD diagnoses with CPT treatment codes essentially tells the story of why care is medically warranted. It provides justification so the clinic can be reimbursed for services. Billing documentation also establishes ongoing necessity for continued treatment. No wonder therapists have to be coding experts!


How Billing Tech Impacts PT Practice?

In many clinics, therapists still have to look up codes manually and complete physical therapy medical billing paperwork by hand. This eats up tons of time that should be spent treating patients.

New digital solutions aim to automate parts of the cumbersome billing workflow:

  • Automated coding – Software analyzes session notes then suggests appropriate billing codes. Huge time saver!
  • Structured notes templates – Standardized forms for session documentation make record-keeping way more efficient.
  • Real-time claim screening – Claims can be instantly checked for errors to prevent denials before submission.
  • Data analytics – Reporting provides visibility into trouble spots like reasons claims are being rejected. This allows for targeted process improvements.

With less time wasted on billing, therapists can put more effort into delivering excellent, personalized care. And accurate coding means way fewer claims getting denied or delayed—making life easier for your patients. It’s a win-win.


What Are Physical Therapy Billing Units?

In the context of physical therapy, billing units refer to a measurement used in the billing and reimbursement process for healthcare services. Physical therapy services are often quantified and billed based on units, which are standardized increments of time or specific procedures.

Here are a few common ways physical therapy billing units are used:

  1. Time-Based Units: Physical therapy sessions may be billed in units of time, typically in 15-minute increments. For example, a 30-minute session might be billed as two units.
  2. Procedural Units: Certain physical therapy procedures or interventions have assigned unit values. These can include specific exercises, modalities, or therapeutic activities.
  3. Evaluation and Management Units: Initial evaluations and assessments, as well as subsequent follow-up assessments, may be assigned specific unit values.
  4. CPT Codes: The Current Procedural Terminology (CPT) codes are a standard set of codes used to describe medical, surgical, and diagnostic services. Each code corresponds to a specific procedure or service, and the associated units help determine the reimbursement.

What is CPT Code for Physical Therapy?

The Current Procedural Terminology (CPT) code for physical therapy varies depending on the specific service provided. Common CPT codes for physical therapy include:

  1. 97110 – Therapeutic exercises: This code is used for individual or group therapeutic exercises to improve strength, range of motion, flexibility, and coordination.
  2. 97112 – Neuromuscular reeducation: This code is used for activities that focus on the restoration of functional movement patterns through the facilitation of normal movement or through the inhibition of abnormal movement patterns.
  3. 97116 – Gait training (includes stair climbing): This code is used for activities that focus on improving a patient’s ability to walk and navigate various surfaces.
  4. 97140 – Manual therapy techniques: This code covers hands-on techniques, such as mobilization or manipulation of joints and soft tissues, to improve mobility and reduce pain.
  5. 97530 – Therapeutic activities: This code includes dynamic activities to improve functional performance, such as balance and coordination exercises.

It’s important to note that these codes may be subject to updates, and the specific code used can depend on the nature of the physical therapy service provided. Healthcare providers and billing staff should refer to the most recent version of the CPT codebook and any relevant updates or guidelines from relevant authorities.


The Takeaway

While billing and coding seems far removed from clinical practice, it’s a core part of running a thriving PT clinic. When billing goes smoothly, therapists can pour their energy into delivering the hands-on care and personal attention patients deserve.