Just like with most specialties, physical therapy and occupational billing have their own special coding and billing obstacles. Providers have to understand the guidelines every payer follows for their time-based reporting, and they have to make sure they count carefully. These are the six best courses of action you can take to stay on top, guarantee coding compliance, and not have to deal with payer scrutiny.
Document the Complexity of PT and OT Evaluations
There are CPT codes that specify levels of complexity: low, moderate, or high. This means that the providers have to know, and document, the components that support the designation. If you need it, the CPT manual can be a valuable resource if you feel unsure.
Specify Places on the Body
It’s important to identify which parts of the patient’s body were treated. That’s why, after treatment is done, part of physical therapy billing means documenting whatever muscles and joints on the body were treated. This helps you justify your CPT codes that require that therapy was done on at least one part of the body. Also, it helps payers know about certain injuries which lets them assign liability.
Count Units of Time Carefully
First, you need to find out if your payer requires providers to add all of the time-based services together or if every time-based service is reported separately. If you don’t know what your payers are doing, it will be tougher for the services to get paid for properly.
Something of note is that the CPT manual mentions that a single unit of time happens once the provider reaches the midpoint of a time-based service. For physical and occupational billing, eight minutes is the midpoint.
Understand When You Should Apply Modifier-59
Modifier-59 might apply in occupational and physical therapy billing whenever the same provider does multiple timed procedures in the same day, but at different times during that day. As an example, if a provider does manual therapy for a patient from 9:00-9:15, then does therapeutic activities between 9:15 and 9:30, both services can be reported using modifier-59.
Providers should never bill a time-based code for more than one patient at once unless they can prove that the services were done at different times or if they were performed accompanied by a PT or OT assistant. That assistant also has to be a reimbursable provider in the payer’s contract.
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