Physical Medicine|Physical Therapy - Articles

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities
July 13th, 2022 - Dr. Evan M. Gwilliam, DC, MBA, QCC, CPC, CCPC, CPMA, CPCO, AAPC Fellow, Clinical Director
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

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Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program
October 7th, 2020 - Wyn Staheli, Director of Research
To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.
Use the Correct Diagnosis Codes and Revenue Codes to Get Paid for PAD Rehab
July 15th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The initial treatment in rehabilitation for patients suffering from Intermittent Claudication (IC) is Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD).  Rehabilitation using SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.   When reporting 93668 for peripheral arterial disease rehabilitation the following ...
Are NCCI Edits Just for Medicare?
July 14th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
Hypertension ICD-10-CM Coding Table, Guidelines, and Tips
April 16th, 2020 - Wyn Staheli, Director of Research & Aimee Wilcox, Director of Content
Coding hypertension properly requires knowing all the guidelines. This article summarizes how hypertension is coded using ICD-10-CM and includes tips, definitions and a very helpful coding table summarizing your options.
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
March 31st, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
New Biofeedback Codes to replace 90911 Eff 2020-01-01
March 26th, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
CMS announced 90912 and 90913 are to be used starting January 2020 in place of 90911. According to CMS MLN, these new codes, designated as “sometimes therapy”, are reported to furnish these services outside a therapy plan of care when appropriate. Codes are permitted to be used by physicians and Non-Physician Practitioners (NPPs), ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
New Codes for Dry Needling
September 30th, 2019 - Wyn Staheli, Director of Research
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
July 17th, 2019 - Wyn Staheli, Director of Research
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
July 15th, 2019 - Wyn Staheli, Director of Research
Question: It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
July 8th, 2019 - Wyn Staheli, Director of Research
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?
May 27th, 2019 - Wyn Staheli, Director of Research
Question Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3. Also, it shows the ...
RT and LT Modifier Usage Change (effective 2019-03-01)
May 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...
Podiatrist Billing for Physical Therapy
March 7th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
It is not uncommon for a Podiatrist to offer Physical therapy as an ancillary service to help promote healing and convenience for their patients. If this is a part of your practice be sure you are aware of the rules and policies from your local MAC carrier and your payer policies on ...
Answers to Your Auditing & Compliance Questions
March 4th, 2019 - Namas
National Alliance of Medical Auditing Specialists (NAMAS) hosts a forum where auditing and compliance professionals can get answers to their questions, and exchange information with other professionals across the country. Recently, we've received the following question regarding fracture care that we'd like to share below. Q: I recently noticed CPT 26600, ...
Physical Therapy Caps Q/A
February 1st, 2019 - Wyn Staheli, Director of Research
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
CPT Modifiers 96 & 97 for Habilitative and Rehabilitative Services (2018-01-01)
January 22nd, 2019 - Find-A-Code
Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. There have been questions on whether modifier 96 will be preferred over HCPCS modifier SZ, which describes the same types of habilitative (but not rehabilitative) services, but payers have not yet indicated which modifier ...
Muscle Testing and Range of Motion Information
November 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?
October 16th, 2018 - Wyn Staheli, Director of Research
Question: We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...
Rhizotomy Procedures
September 26th, 2018 - BC Advantage
The terms “rhizotomy” and “Radiofrequency Ablation” (RFA) both mean “destruction of a nerve.” Another term for this is “neurolysis.” The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve(s). Nerve Destruction choices include the following: Chemical Neurolytic Blocks - These require substances that are...
Q/A: Can I Bill Mechanical Massage?
August 16th, 2018 - Wyn Staheli, Director of Research
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
Q/A: Can I Bill Spinal Decompression Table to Insurance?
July 25th, 2018 - Wyn Staheli, Director of Research
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
Q/A: Should I Bill Massage as 97124 or 97140?
June 20th, 2018 - ChiroCode
Question The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
June 18th, 2018 - Wyn Staheli, Director of Research
Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.
Auditing Therapy Evaluation Codes - Not So Quick!
June 4th, 2018 - Nancy J Beckley, MS, MBA, CHC
New evaluation codes for physical therapy (PT) and occupational therapy (OT) codes were made effective 1/1/2017. Three new physical therapy evaluation codes replaced 97001, and three new occupational evaluation codes replaced 97003. Chart 1 - Short Code Descriptors The PT and OT reevaluation codes remain the same but were...
When is 97112 Neuromuscular Re-education Billable?
March 13th, 2018 - Dr. Evan Gwilliam, VP for PayDC
Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.
Increased Therapy Denials Create Administrative Burden
March 5th, 2018 - Wyn Staheli, Director of Research
Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues ...
CPT Modifers 96 & 97 for Habilitative and Rehabilitative Services
February 27th, 2018 - Jared Staheli
Effective January 1, 2018, CPT modifiers 96 "habilitative services" and 97 "rehabilitative services" will be in effect. CMS has added modifiers 96 and 97 to their edits (see MLN Matters MM10385 here) and modifier SZ is deleted as of December 31, 2017. Private payers should simply adjust their policies to use ...
Physical Therapists: Rules For Nerve Conduction And Needle Electromyographic (EMG) Codes
February 1st, 2018 - Find-A-Code
According to Noridian L35081, nerve conduction code 95905 does not have levels of supervision 21, 22, 6a, 66, 77 or 7a assigned to it and is therefore not allowed by Physical Therapists. Nerve conduction codes 95907-95913 had their Physician Supervision of Diagnostic Tests Indicators adjusted to 7A effective 01/01/2013 (CR 8169). Therefore, if authorized by state law, ...
Strapping and Kinesio Taping Coding Differences
February 1st, 2018 - Wyn Staheli, Director of Research
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally. Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue. Coding: ...
Medicare Requiring Modifier GP on Physical Therapy Services
February 1st, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following (emphasis added): Services furnished under the Outpatient ...
Billing with a GP Modifier
January 15th, 2018 - Wyn Staheli, Director of Research
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following: Services furnished under the Outpatient ...
Outpatient Rehabilitation Modifiers
January 9th, 2018 - Jared Staheli
Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries. For services delivered under an outpatient plan of care use modifier: GN for speech-language pathology GO for occupational therapy GP for physical therapy In addition to using the correct modifier, ...
Proper Usage of Electrical Stimulation
January 4th, 2018 - Find-A-Code
According to CGS Administrators, most non-wound care electrical stimulation treatment provided in therapy should be billed as G0283 as it is often provided in a supervised manner (after skilled application by the qualified professional/auxiliary personnel) without constant, direct contact required throughout the treatment. 97032 is a constant attendance electrical stimulation modality ...
Skilled Therapy, When it's Appropriate and Billable
January 4th, 2018 - Find-A-Code
According to CGS Administrators, "A service is not considered a skilled therapy service merely because it is furnished by a therapist or by a therapist/therapy assistant under the direct or general supervision, as applicable, of a therapist. If a service can be self-administered or safely and effectively furnished by an unskilled person, ...
Beware of Limitations When Using Electrical Stimulation - Ultrasound
January 4th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Ultrasound is often used to reduce inflammation, and improve the flexibility of connective tissue. This is done by applying sound waves to produce heat and/or vibration. Be aware of the many limitations when reporting this code. Be sure to consult your local carrier LCDs and carefully determine the correct code and the requirements for ...
Billing Negative Pressure Wound Therapy (NPWT) (disposable device)
January 4th, 2018 - Find-A-Code
Per CMS: Disposable NPWT services are billed using the following Current Procedural Terminology® (CPT®) codes: 97607 - Negative pressure wound therapy, (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or ...
Diathermy eg Microwave Use and Documentation
January 4th, 2018 - Find-A-Code
According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.Diathermy achieves ...
General Physical Therapy Modality Guidelines
January 4th, 2018 - Find-A-Code
According to CGS Administrators, CPT codes 97012, 97016, 97018, 97022, 97024, 97026, and 97028 require supervision by the qualified professional/auxiliary personnel of the patient during the intervention. CPT codes 97032, 97033, 97034, 97035, 97036, and 97039 require direct (one-on-one) contact with the patient by the provider (constant attendance). Coverage for these codes ...
Hydrotherapy Guidelines
January 4th, 2018 - Find-A-Code
According to CGS Administrators, hydrotherapy involves the patient’s immersion in a tank of agitated water in order to relieve muscle spasm, improve circulation, or cleanse wounds, ulcers, or exfoliative skin conditions.Qualified professional/auxiliary personnel one-on-one supervision of the patient is required. If the level of care does not require the skills of ...
Initial Evaluation Codes for PT's and OT's
January 4th, 2018 - Find-A-Code
According to CGS Administrators, for initial evaluations, PTs shall use code 97161-97163 and OTs shall use code 97164-97167. Physicians and other qualified non-physician providers should use the evaluation and management codes 99201-99350 for evaluations.Consider the following points when billing for an evaluation. These evaluation codes are untimed, billable as one unit. Do ...
Mechanical Traction Therapy
January 4th, 2018 - Find-A-Code
According to CGS Administrators, traction is generally limited to the cervical or lumbar spine with the expectation of relieving pain in or originating from those areas.Specific indications for the use of mechanical traction include cervical and/or lumbar radiculopathy and back disorders such as disc herniation, lumbago, and sciatica.This modality is typically used in conjunction with ...
Physical Therapist can now bill for a substitute Physical Therapist
January 4th, 2018 - Find-A-Code
As of 6/13/2017 Medicare contractors shall accept claims from Physical Therapists, Provider Specialty 65 – Physical Therapist in Private Practice, for services provided by a substitute physical therapist under a fee-for-time compensation arrangement when submitted with the Q6 modifier. The A/B MAC Part B may pay the patient’s regular physician for physicians' ...
PT and OT Reevaluation Coding
January 4th, 2018 - Find-A-Code
According to CGS Administrators, the reevaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment, or terminating services. Reevaluation provides additional objective information not included in other documentation, such as treatment or progress notes.Reevaluations are distinct from therapy ...
Reimbursement for Therapy Students
January 4th, 2018 - Find-A-Code
According to CGS Administrators, qualified professionals may serve as clinical instructors for therapy students within their scope of practice. Physical therapist assistants and occupational therapy assistants may only serve as clinical instructors for physical therapist assistant students and occupational therapy assistant students, respectively, when performed under the direction and supervision ...
Ultrasound Therapy
January 4th, 2018 - Find-A-Code
According to CGS Administrators, therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive ...
2017 Physical Therapy Evaluation & Management Codes
September 1st, 2017 - Kathy Price, RHIT, CPC, CCS-P, CPMA
As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy....
Outpatient Physical Therapy Changes Effective June 13th, 2017
June 30th, 2017 - Shannon DeConda
Our friends in clinics operating in Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA), or in a rural area have long struggled with how to cover Physical Therapy services when a therapist is on leave, vacation, or in event of medical leave. The Centers for Medicare and Medicaid ...
Documentation for Physical Therapist
June 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Medical review decisions are based on the information submitted in the medical record. Therefore, it is critical that the medical record information submitted is accurate and complete to allow medical review to make a fair payment decision. The medical record information submitted should: Paint a picture of the patient’s impairments and ...
Therapy Caps, Limits and Providers
May 4th, 2017 - Chris Woolstenhulme, CPC, CMRS
The annual combined therapy cap is per beneficiary each calendar year. For 2017, this includes Medicare Part B outpatient therapy cap for Occupational Therapy (OT) $1,980, Physical Therapy (PT) and Speech-Language Pathology Services (SLP) $1,980. In addition there is an exception process, if the therapy services are higher than the limited amounts, the beneficiary ...
Care Plan Oversight Services
February 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Care Plan oversight services is commonly done but rarely billed. The following codes can only be billed once every 30 days. The use of the following codes are determined by the complexity and approximate time spent by the physician or other health care professional within a 30-day period. G0179 MD re-certification HHA ...
NAMAS: 2017 CPT Updates Bring Big Changes to Physical Therapy
December 16th, 2016 - Find-A-Code
For 2017, the new physical therapy (PT), occupational therapy (OT), and athletic training (AT) evaluation codes are the first major changes to the physical medicine and rehab codes in over twenty years. The new evaluation codes (97161-97168) replace the current PT and OT evaluation codes 97001 and 97003. The...

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