Can you bill manipulation and the manual therapy 97140 CPT code? (2022)

Can you bill manipulation and the manual therapy 97140 CPT code? (1)

Does your documentation allow you to bill both a manipulative treatment and manual therapy with the 97140 CPT code?

I started working for the American Chiropractic Association (ACA) in June 1999 in the Professional Development Department, which had responsibility for coding. From my very first day, I fielded calls from members asking about the newfangled manual therapy 97140 CPT code that went into effect that prior January. Five codes were eliminated in favor of this new manual therapy code.

To say the change left confusion in its wake is an understatement.

The pesky early years of the 97140 code

One of the biggest challenges faced by doctors of chiropractic (DCs) was that the old code 97150-Myofascial Release, which many providers used for trigger-point therapy, was billed along with the CMT code for any muscle work performed in conjunction with the adjustment. However, with the CPT® update in 1999, more clarity began to emerge about what exactly was to be included with the adjustment and what wasn’t.

(Video) Confusing Codes for Chiropractors 🤷‍♀️ 97110 versus 97112 versus 97530

Many payers took the position at that time that 97140 was to be considered “mutually exclusive” with the CMT service in many circumstances. Providers were advised to use the 59 modifier when providing both CMT and 97140 to delineate that the services were separately identifiable. That was supposed to mean a separately identifiable area for the 97140 vs. the CMT service. That was not always the case.

Some providers performed both in the same anatomical region and billed with the 59 modifier anyway. Then, upon audit, it was revealed that the providers billed using the 59 modifier when the service was not performed in separate regions. Since so many providers were found to have “done it wrong,” a knee-jerk reaction ensued when some payers never covered both CMT and 97140 on the same visit. Only upon appeal, with clear documentation of the separately identifiable regions, would the 97140 CPT code service be paid.

The pesky 97140 CPT Code: 2021

Some payers, such as Optum, have finally taken the guesswork out of when and how to append the -59 modifier when performing CMT along with procedure code 97140 –manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction) on one or more regions (15 minutes each).

This, coupled with providers beginning to better understand when both services are billable on the same visit, has loosened the noose we felt as a profession in previous years. But, as more clarification has come forth, some providers are still stuck in the past and unaware of the rules they are expected to follow when billing both. Some, like Optum, have clarified their policy for when both services are billable and payable.

(Video) Overview of PT CPT Codes and BIlling

We have a member who deals with Optum as the payer for Veterans Affairs (VA) patients, and who is dealing with this situation now. They hadn’t kept up with the rules, and were billing both services at the same time, incorrectly. So far, almost $20,000 has been recouped from the provider due to the billing errors. Let’s make sure you don’t find yourself in a similar situation.

A summary of Optum’s policy on CMT/97140

“Manipulation and Manual Therapy CPT® code 97140 (Manual therapy techniques) may be billed on the same date of service as a CMT code when the manual therapy service is provided to adifferent, noncontiguous body regionthan the CMT…CMS has established the following four HCPCS modifiers (referred to collectively as –X{EPSU} modifiers) to define specific subsets of the -59 modifier: XE Separate Encounter; XS Separate Structure; XP Separate Practitioner; XU Unusual Non-Overlapping Service…The National Correct Coding Initiative (NCCI) Edits – developed by the CMS – provides guidance in the application of modifier – 59.Different diagnoses are not adequate criteria for use of modifier -59.The HCPCS/CPT codes remain bundled unless the procedures/surgeries areperformed on different anatomic sitesor during separate patient encounters…. From an NCCI perspective, the definition of different anatomic sites includesdifferent organs or different lesions in the same organ. However, the treatment ofcontiguous structures in the same organ or anatomic regiondoes notconstitute treatment of different anatomic sites. [NCCI, 2017]”

This means that you can append either the -59 modifier or the X modifiers; both are accepted forms of billing at this time. But what about the reference tononcontiguous body region? For us to understand Optum’s interpretation of body regions we should start with what is considered a “region” when reporting CMT. The policy says:

For the purposes of reporting CMT codes, there are five spinal regions and five extraspinal regions. The spinal regions are: cervical (includes the atlantooccipital joint); thoracic (includes costotransverse and costovertebral joints); lumbar, sacral; and pelvic (sacroiliac joint). The extraspinal regions are: head (including the temporomandibular joint, but excluding the atlantooccipital joint); lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints); and abdomen.”

(Video) Billing 97140 with Your CMT

Notice how Optum pulls it all together. Optum clarifies contiguous and non-contiguous body regions as follows:

“The treatment of myofascial structures using manual therapy techniques in the same organ (spine), where CMT was performed and was contiguous(cervical and thoracic), does not constitute treatment of different anatomic sites.

The treatment of myofascial structures using manual therapy techniques in the same organ (spine), where CMT was performed andwas not contiguous (cervical and lumbar), does constitute treatment of different anatomic sites.

The treatment of thecervical spine and a shoulder joint does constitute treatment of different anatomic sites.”

(Video) Billing Timed Therapy Codes

Compliance with billing/documentation rules

Optum, like most payers, publishes their Medical Review Policy (MRP) for such things and providers who bill the payer should take heed of the rules of the game. These are important factors to review before billing these services, ensuring that the clinical record clearly matches the CPT® codes billed:

  • Manipulation was not performed to the same anatomic region or a contiguous anatomic region (e.g., cervical and thoracic regions were contiguous; cervical and pelvic regions were noncontiguous)
  • The clinical rationale for a separate and identifiable service must be documented (e.g., contraindication to CMT is present)
  • Description of the manual therapy technique(s) location (e.g., spinal region(s), shoulder, thigh, etc.)
  • Time (e.g., number of minutes spent performing the services associated with this procedure) meets the timed-therapy services requirement
  • The 97140 CPT code is appended with the modifier -59 or the appropriate -X modifier

If you are billing 98941 along with 97140, you may find it very difficult to meet all of the criteria listed above. In addition to documentation, be sure your billing is consistent with the reason given for performing 97140 by pointing to the correct diagnosis code. The reason (diagnosis/condition) for performing CMT should never be the same as 97140 when billing. See a proper billing example below:

How would you answer these questions?

Considering the increasing scrutiny and number of audits, it’s time for a self-check to make sure you have what’s necessary to properly bill both CMT and 97140 on the same visit:

  • Is the manual therapy performed as a pre-cursor to the adjustment in the same or a contiguous body region? If so, you shouldn’t charge for both.
  • Is the manual therapy performed in a separate, non-contiguous body region? If so, make sure you clarify separate diagnoses, document both conditions, and include both services in your treatment plan at the beginning of the episode of care.
  • Do you use diagnosis pointers when listing the procedure 97140 CPT code? If so, are they pointing to the same diagnosis as the CMT?

If you routinely perform both CMT and 97140, make sure you pay attention to the coding guidelines provided by the payers with whom you deal. Look for MRP that outlines their rules for billing both services at a time and what they expect to be present in the documentation.

(Video) Target Coding CPT & ICD 10 Code Pairing

KATHY WEIDNER, better known professionally as Kathy Mills Chang, is a certified medical compliance specialist (MCS-P) and a certified chiropractic professional coder. Since 1983 she has been providing chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. She leads the largest team of certified specialists under one roof in the profession, at KMC University, and is known as one of the profession’s foremost experts on Medicare and documentation. She or any of her team members can be reached at 855-TEAM-KMC or info@KMCUniversity.com.

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Procedure CODE AND Description 97140 - Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 97530 - Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 97112 - Therapeutic procedure, 1 or more…

Procedure CODE AND Description97140 – Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 97530 – Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes. EXAMPLE #2: CPT CODE: 97140: Manual Therapy Techniques: (Including manual traction, myofascial release, manual lymphatic drainage) Using Code 97140: Manual Therapy Techniques.. When reporting or billing for CPT 97112 (neuromuscular re-education) and CPT 97124 (massage), as well as all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical site, description of service, and time (as required by the selected CPT code).. At least eight minutes of a physical therapy timed service must be provided in order to use a therapy procedure code (i.e. 97140 – manual therapy techniques, one or more regions, each 15 minutes).. You are unable to bill for the ultrasound because the total time of timed units that can be billed is constrained by the total timed code treatment minutes (i.e., you may not bill 4 units for less than 53 minutes regardless of how many services were performed).. 24 minutes of neuromuscular reeducation, code 97112,. 23 minutes of therapeutic exercise, code 97110,. Total timed code treatment time was 47 minutes.. The correct coding is 2 units of code 97112 and one unit of code 97110, assigning more timed units to the service that took the most time.. When reporting or billing for CPT 97112 (neuromuscular re-education) and CPT 97124 (massage), as well as all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be recorded in the medical record, including clinical rationale, anatomical site, description of service, and time (as required by the selected CPT code).. Group 1 Codes 95992 Canalith repositioning proc. 97001 Pt evaluation. 97002 Pt re-evaluation. 97003 Ot evaluation. 97004 Ot re-evaluation. 97012 Mechanical traction therapy. 97016 Vasopneumatic device therapy. 97018 Paraffin bath therapy. 97022 Whirlpool therapy. 97024 Diathermy eg microwave. 97028 Ultraviolet therapy. 97032 Electrical stimulation. 97034 Contrast bath therapy. 97035 Ultrasound therapy. 97036 Hydrotherapy. 97039 Physical therapy treatment. 97110 Therapeutic exercises. 97112 Neuromuscular reeducation. 97113 Aquatic therapy/exercises. 97116 Gait training therapy. 97124 Massage therapy. 97139 Physical medicine procedure. 97140 Manual therapy 1/> regions. 97150 Group therapeutic procedures. 97530 Therapeutic activities. 97532 Cognitive skills development. 97533 Sensory integration. 97535 Self care mngment training. 97537 Community/work reintegration. 97542 Wheelchair mngment training. 97545 Work hardening. 97546 Work hardening add-on. 97750 Physical performance test. 97755 Assistive technology assess. 97760 Orthotic mgmt and training. 97761 Prosthetic training. 97762 C/o for orthotic/prosth use. 97799 Physical medicine procedure. G0283 Elec stim other than wound. Similarly, if two therapy assistants provide services to the same patient at the same time, only the service of one therapy assistant can be billed by the supervising therapist or the service units can be split between the two therapy assistants and billed by the supervising therapist(s).. 97035* GP Ultrasound therapy X Timed 15 min units. 97036* GP Hydrotherapy X Timed 15 min units. 97039* GP Physical therapy treatment X. 97110* GP, GO Therapeutic exercises X X Timed 15 min units. 97112* GP, GO Neuromuscular reeducation X X Timed 15 min units. 97113* GP, GO Aquatic therapy/exercises X X Timed 15 min units. 97116* GP Gait training therapy X Timed 15 min units. 97124* GP, GO Massage therapy X X Timed 15 min units. 97139* GP Physical medicine procedure X. 97140* GP, GO Manual therapy X X Timed 15 min units. 97150* GP, GO Group therapeutic procedures X X. 97165 GO DSHS OT eval (bed rail assessment) X. EPA required.

Created and maintained by the American Medical Association, Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic services.

In short, CPT codes are procedure codes and ICD-10 codes are patient diagnosis codes.. In most cases, therapists bill for “true” telehealth services using the same CPT codes they would bill for services provided in the clinic (typically with some type of telehealth modifier affixed to the claim, per the individual payer’s guidelines).. The National Correct Coding Initiative (NCCI) has identified procedures that therapists commonly perform together and labeled these “edit pairs.” Thus, if you bill a CPT code that is linked to one of these pairs, you’ll receive payment for only one of the codes.. CPT CodeDescriptionTimed?Column 2 y = use 59 modifier n = do not bill the code in combination with code in column 1 90912Biofeedback Pelvic Health: Initial 15 MinutesY90901n; 97032y; 97530y90913Biofeedback Pelvic Health: Each Additional 15Y90901n; 97032y; 97530yG0451Developmental testingN96125y; 96127n; 96146y; 96160y; 96161y; 96523n92507Treatment of Speech & Language, IndividualN92508Speech GroupN0373Ty; 36591n; 36592n; 69209n; 69210n; 96523n; 97150y;. 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97533y; G0268n92521Evaluation of Speech FluencyN92522Evaluation of Speech ProductionN92523Evaluation of Speech Production with Evaluation of Language Comprehenstion and ExpressionN92524Behavioral and Qualitative Analysis of Voice & ResonanceN92526Treatment of Swallowing DysfunctionN36591n; 36592n; 92511y; 92520y; 96523n; 97032n; 97150y;. 97530y; G0271n; G0283n;92597Evaluation of Voice ProstheticN36591n; 36592n; 96523n92607Evaluation of Speech Generating Device; First HourY36591n; 36592n; 92508y; 92597n; 92609y; 96523n92608Eval of Speech Device (each additional 1/2 hour)Y36591n; 36592n; 96523n92609Programming and Training for Speech Generating DeviceN36591n; 36592n; 92508y; 96523n92610Evaluation of SwallowingN35691n; 35692n; 92511y; 96523n92611Modified Swallow StudyN36591n; 36592n; 70370y; 70371n; 76120n; 76125n; 92511y;. 92610y; 96523n92612Flexible Endoscopic Eval of SwallowingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n;. 92610y; 92611y; 92614n; 96523n92614Flexible Endoscopic Evaluation; Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n;. 92610y; 92611y; 96523n92616Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensory Testing by Cine or Video RecordingN31575n; 36591n; 36592n; 76120n; 76125n; 92511n; 92520n;. 92610y; 92611y; 92612n; 92614n; 96523n95992Canalith Re-positioningN36591n; 36592n; 92531n; 92532n; 96523n; 97140y; 97530y96105Assessment of AphasiaY36591n; 36592n; 96110y; 96125y; 96127n; 96146n; 96523n;. 97151n; 97152n; 97153n; 97154n; 97155n; 97156n; 97157n;. 97158n; G0451y96110Developmental Testing, LimitedN36591n; 36592n;; 96125y; 96146n; 96523n; 97151n; 97152n;. 97153n; 97154n; 97155n; 97156n; 97157n; 97158n96112Developmental Test Administration; First HourY0362Tn; 0373Tn; 36591n; 36592n; 90849y; 90865y; 90870y;. 90880y; 92002y; 92004y; 92012y; 92014y; 96105y; 96110n;. 96125y; 96127n; 96146n; 96523n; 97151n; 97152n; 97153n;. 97154n; 97155n; 97156n; 97157n; 97158n; G0380y; G0381y; G0382y; G0383y; G0384y; G0410y; G0411y; G0451n; G0463y;. Check E&M Codes as well (99201 – 99497)96113Developmental Test Administration; Each Additional 30 MinutesY0362Tn; 0373Tn; 36591n; 36592n; 90849y; 90865y; 90870y;. 90880y; 92002y; 92004y; 92012y; 92014y; 96110n; 96125y;. 96127n; 96146n; 96523n; 97151n; 97152n; 97153n; 97154n;. 97155n; 97156n; 97157n; 97158n; G0380y; G0381y; G0382y; G0383y; G0384y; G0410y; G0411y; G0451n; G0463y; Check. E&M Codes as well (99201 – 99497)96125Standardized Cognitive Performance TestingY36591n; 36592n; 96127n; 96146n; 96523n; 97151n; 97152n;. 97153n; 97154; 97155n; 97156n; 97157n; 97158n29581Multi-Layer Compression System – Below KneeN29540y; 29550y; 29580y; 64451n; 64454y; 97140y29584Multi-Layer Compression System – Entire ArmN29125y; 29126y; 29130y; 29131y; 29260y; 64451n; 64454y;. 97140y97012Mechanical TractionN96523n; 97018y; 97140yG0281Electrical Stimulation – Stage 3-4 WoundsN96523n; 97032y; G0283yG0283Electrical Stimulation – Other Than Wound CareN64451y; 64454y; 96523n; 97032y97016Vasopneumatic DeviceN96523n; 97018y; 97026y97018Paraffin BathN96523n; 97022y97022WhirlpoolN96523n; 97602y97024DiathermyN96523n; 97018y; 97026y97026InfraredN96523n; 97018y; 97022y97028UltravioletN96523n; 97018y; 97022y; 97026y97032Electrical Stimulation, ManualY96523n97033IontophoresisY96523n97034Contrast BathY96523n97035UltrasoundY96523n97036Hubbard TankY96523n97039Unlisted ModalityY96523n97110Therapeutic ExercisesY97112Neuromuscular Re EducationY97113Aquatic Therapy/ExercisesY36591n; 36592n; 96523n; 97022y; 97036n97116Gait TrainingY97124MassageY36591n; 36592n; 96523n97129Cognitive Function – Initial 15 MinutesY36591n; 36592n; 96523n; 97153n; 97155n97130Cognitive Function – Each Additional 15 MinutesY36591n; 36592n; 96523n; 97153n; 97155n97139Physical Medicine ProcedureY36591n; 36592n; 96523n97140Manual TherapyY95851y; 95852y; 96523n; 97018y; 97124n; 97530y97150Group Therapeutic ProceduresN95851n; 96523n; 97113y; 97124y; 97127y; 97140y; 97153n;. 97154n; 97155n; 97156n; 97157n; 97158n; 97530y; 97533y;. 97537y; 97542y; 97763y97151Behavior Identification AssessmentY0403Tn; 0488Tn; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 96523n97152Behavior Identification – Supporting AssessmentY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90889n; 96523n97153Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 92508n; 96523n97154Group Adaptive Behavior Treatment by ProtocolY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 96523n97155Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 96523n97156Family Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 96523n97157Multiple-Family Group Adaptive Behavior Treatment GuidanceY0403Ty; 0488Ty; 36591n; 36592n; 90867n; 90868n; 90869n;. 90882n; 90889n; 96523n97158Group Adaptive Behavior Treatment by Protocol ModificationY0403Ty; 0488Ty; 36591n; 36592n; 90849n; 90863y; 90865n;. 90867; 90868n; 90869n; 90870n; 90875n; 90876n; 90880n;. 90882n; 90885n; 90887n; 90889n; 96523n97161Physical Therapy Eval – Low ComplexityN97162Physical Therapy Eval – Moderate ComplexityN97163Physical Therapy Eval – High ComplexityN97164Physical Therapy Re-evaluationN97165Occuaptional Therapy Eval – Low ComplexityN97166Occupational Therapy Eval – Moderate ComplexityN97167Occupational Therapy Eval – High ComplexityN97168Occuptional Therapy Re-evaluationN97530Therapeutic ActivitiesY36591n; 36592n; 95851n; 95852n; 96523n; 97113y; 97153n;. 97154n; 97155n; 97156n; 97157n; 97158n; 97533y; 97537y;. 97542y97533Sensory IntegrationY36591n; 36592n; 96523n; 97153n; 97154n; 97155n; 97156n;. 97157n; 97158n97535Self Care/Home Management TrainingY97537Community/Work ReintegrationY36591n; 36592n; 96523n97542Wheelchair Management – Assessment and TrainingY36591n; 36592n; 96523n97545Work Hardening; First 2 HoursY36591n; 36592n; 96523n; 97140n97597Wound Care Selective First 20 sq centimetersN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y;. 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y;. 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y;. 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y;. 29581y; 29584y; 96523n; 97022y; 97602n; 97605y; 97606y;. 97607y; 97608y; (Check other E&M codes)97598Wound Care Selective; Each additional 20 sq centimeters or any part thereofN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y;. 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y;. 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y;. 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y;. 29581y; 29584y; 96523n; 97022y; 97602n; 97605y; 97606y;. 97607y; 97608y; 97610y, (Check other E&M codes)97602Wound Care Non-SelectiveN29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y;. 29260y; 29280y; 29305y; 29325y; 29345y; 29355y; 29358y;. 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y;. 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y;. 29581y; 29584y; 96523n; 97607n; 97608n97605Negative Pressure Wound Therapy < or = to. 50sq cm using Durable Medical EquipmentN36591n; 36592n; 96523n; 97602n; 97607y; 97608n; 97610y97606Negative Pressure Wound Therapy Greater than. 50sq cm using Durable Medical EquipmentN36591n; 36592n; 96523n; 97602n; 97605n; 97607n; 97608y;. 97610y97607Negative Pressure Wound Therapy < or = to. 50sq cm using non-Durable Medical EquipmentN36591n; 36592n; 96523n97608Negative Pressure Wound Therapy Greater than. 50sq cm using non-Durable Medical EquipmentN36591n; 36592n; 96523n; 97607n97610Low Frequency, Non-Contact, Non-Thermal UltrasoundN36591n; 36592n; 96523n; 97035y; 97602n; 97607y; 97608y97750Physical Performance Test or MeasurementY97755Assistive Technology AssessmentY97760Orthotic Management & Training, Initial Orthotic(s) EncounterY97761Prosthetic Management & Training, Initial Prosthetic(s) EncounterY97763Orthotic/Prosthetic Management and/or Training, Subsequent Orthotic/Prosthetic Encounter(s)Y0213Ty; 0216Ty; 0228Ty; 0229Ty; 0230Ty; 0231Ty; 29044y;. 29046y; 29049y; 29055y; 29058y; 29065y; 29075y; 29085y;. 29105y; 29125y; 29126y; 29130y; 29131y; 29200y; 29240y;. 29260y; 29280; 29305y; 29325y; 29345y; 29355y’ 29358y;. 29365y; 29405y; 29425y; 29435y; 29440y; 29445y; 29450y;. 29505y; 29515y; 29520y; 29530y; 29540y; 29550y; 29580y;. 29581y; 29584y; 36591n; 36592n; 96523n; 97016y; 97124y;. 97140y As of January 1, 2017, PTs and OTs should no longer use the CPT codes 97001, 97002, 97003, and 97004 to bill for initial evaluations and re-evaluations.. 97161Physical therapy evaluation: low complexity97162Physical therapy evaluation: moderate complexity97163Physical therapy evaluation: high complexity 97165Occupational therapy evaluation: low complexity97166Occupational therapy evaluation: moderate complexity97167Occupational therapy evaluation: high complexity 97164Re-evaluation of physical therapy established plan of care requiring: An examination (including a review of history and use of standardized tests and measures) A revised plan of care (based on use of a standardized patient assessment instrument and/or measurable assessment of functional outcome)

Most common PT CPT codes: 97110 (Therapeutic Exercise), 97112 (Neuromuscular Re-education), and 97116 (Gait Training) — but they're not all you'll use.

97110: Therapeutic Exercise 97112: Neuromuscular Re-education 97116: Gait Training 97140: Manual Therapy 97150: Group Therapy 97530: Therapeutic Activities 97535: Self-Care/Home Management Training 97750: Physical Performance Test or Measurement 97761: Prosthetic Training 292**, 295**: Strapping 90901, 90911: Biofeedback. The time spent providing these services cannot be included in your calculations of timed units and are considered separate billing codes.. Timed codes: These codes are based on the time spent one-on-one with the patient and include only skilled interventions.. 97010: Hot or cold packs therapy 97012: Mechanical traction therapy 97014: Electric stimulation therapy 97016: Vasopneumatic device therapy 97018: Paraffin bath therapy 97022: Whirlpool therapy 97026: Infrared therapy 97028: Ultraviolet therapy 97032: Electrical stimulation 97033: Electric current therapy 97034: Contrast bath therapy 97035: Ultrasound therapy 97036: Hydrotherapy 97039: Physical therapy treatment 97113: Aquatic therapy/exercises 97124: Massage therapy 97127: Therapeutic interventions with a focus on cognitive function 97139: Physical medicine procedure 97151: Behavioral identification assessment 97153: Adaptive behavior treatment by protocol 97154: Group adaptive behavior treatment by protocol 97155: Adaptive behavior treatment by protocol (modification) 97156: Family adaptive behavior treatment guidance 97157: Multi-family adaptive behavior treatment guidance 97158: Group adaptive behavior treatment 97161: PT evaluation, low complexity, 20 minutes 97162: PT evaluation, moderate complexity, 30 minutes 97163: PT evaluation, high complexity, 45 minutes 97164: PT re-evaluation 97750: Physical performance test 97755: Assistive technology assessment 97760: Orthotic management and training, first encounter 97761: Prosthetic training, first encounter 97763: Orthotic/prosthetic management, subsequent encounters. Using the wrong codes: This one may sound obvious, but consider this: You can make the argument that almost any exercise a patient performs can fall under the code therapeutic exercise.

Use this page to view details for the Local Coverage Article for billing and coding: outpatient physical and occupational therapy services.

The aquatic therapy treatment minutes counted toward the total timed code treatment minutes should only include actual skilled exercise time that required direct one-on-one patient contact by the qualified professional/auxiliary personnel.. Etiology and duration of wound Prior treatment by a physician, non-physician practitioner, nurse and/or therapist Stage of wound Description of wound: length, width, depth, grid drawing and/or photographs Amount, frequency, color, odor, type of exudate Evidence of infection, undermining, or tunneling Nutritional status Comorbidities (e.g., diabetes mellitus, peripheral vascular disease) Pressure support surfaces in use Patient’s functional level Skilled plan of treatment, including specific frequency, modalities and procedures Type of debridement performed, including instrument used, to support the debridement code billed Changing plan of treatment based on clinical judgment of the patient’s response or lack of response to treatment. Etiology and duration of wound Type of prior treatments by a physician, non-physician practitioner, nurse and/or therapist that failed, including the duration of the failed treatment Stage of wound Description of wound: length, width, depth, grid drawing and/or photographs Amount, frequency, color, odor, type of exudate Evidence of infection, undermining, or tunneling Nutritional status Comorbidities (e.g., diabetes mellitus, peripheral vascular disease) Pressure support surfaces in use Patient’s functional level Skilled plan of treatment, including specific frequency of the modality Changing plan of treatment based on clinical judgment of the patient’s response or lack of response to treatment Frequent skilled observation and assessment of wound healing (at least weekly, but preferably with each treatment session). Paint a picture of the patient’s impairments and functional limitations requiring skilled intervention; Describe the prior functional level to assist in establishing the patient’s potential and prognosis; Describe the skilled nature of the therapy treatment provided; Justify that the type, frequency and duration of therapy is medically necessary for the individual patient’s condition; Clearly document both Timed Code Treatment Minutes and Total Treatment Time in order to justify the units billed; Identify each specific skilled intervention/modality provided to justify coding.. The minutes spent providing untimed services are reflected in the documentation under “Total Treatment Time”(and are not included in the minutes for timed CPT codes when determining the number of timed-based units that may be billed).. The time counted is the time the patient is treated using skilled therapy modalities and procedures, and is recorded in the documentation as “Timed Code Treatment Minutes.” Pre- and post-delivery services are not to be counted when recording the treatment time.. Time spent “supervising” a patient performing an activity that is defined as a timed code, or for the patient to perform an independent activity, even if a therapist is providing the equipment, is considered unbillable time and these minutes should not be counted in the “Timed Code Treatment Minutes.” Therapy timed services require direct, one-on-one patient qualified professional/auxiliary personnel contact, and by definition cannot be billed when performed in a supervised manner.. Whether a single timed code service is provided, or multiple timed code services, the skilled minutes documented in “Timed Code Treatment Minutes’ will determine the number of units billed.. For treatment sessions with both timed and untimed services, the units and time documented for any untimed CPT codes should not be included in the counting of units and time for the timed CPT codes for a calendar day.. Any two CPT codes requiring either constant attendance or direct one-on-one patient contact - as described in (a) or (b) above - (CPT codes 97032-97763), for example, any CPT code for a therapeutic procedure (e.g., 97116 - gait training) with any attended modality CPT code (e.g., 97035 - ultrasound). Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110-97763) with the group therapy CPT code (97150) requiring constant attendance, for example, group therapy (97150) with neuromuscular reeducation (97112). Any CPT code for modalities requiring constant attendance (CPT codes 97032-97039) with the group therapy CPT code (97150) for example, group therapy (97150) with ultrasound (97035). Any evaluation or reevaluation code (CPT codes 97161-97168) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032-97039), therapeutic procedures (CPT 97110-97763) and group therapy (CPT code 97150)

Number: 0325

Physical therapy is the treatment of disorders or injuries using physical methods or modalities.. Three taping conditions were randomly applied: therapeutic taping, control taping, and no taping.. All outcome measures significantly improved after 4 weeks of treatment.. Each participant was tested under 3 conditions: with the ankle taped with non-elastic, white sports tape, Kinesio tape, and with no tape.. Significantly greater mean muscle activity was found when ankles were taped with non-elastic tape compared to no tape, while Kinesio tape had no significant effect on mean or maximum muscle activity compared to the no tape condition.. Chang and colleagues (2015) performed a systematic review comparing the effects of Kinesio taping with McConnell taping as a method of conservative management of patients with PFPS.. Kinesio taping could be applied to muscles to relieve pain, but there was a lack of evidence on effect of the effects of taping on patellar alignment correction.. These investigators examined the effectiveness of physical therapy on pain and physical function in patients with hip OA.. Physical therapy evaluation;. A randomized controlled trial comparing McKenzie therapy and motor control exercises on the recruitment of trunk muscles in people with chronic low back pain: A trial protocol.

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