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.
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:
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.
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”
CPT Codes – The “What”
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!
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:
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.
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:
The Current Procedural Terminology (CPT) code for physical therapy varies depending on the specific service provided. Common CPT codes for physical therapy include:
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.
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.