Week 14 - Coding & Billing Flashcards
What codes are used for diagnosis?
ICD-10
What are ICD-10 codes used for?
both medical and PT Dx
Do your ICD-10 codes have to match the medical Dx?
No, unless insurance or facility require it
If I suspect a patient has a herniated disc but they have no imaging, do i code for a herniated disc?
No, you only code to the level you can confirm
What codes are used for interventions?
CPT-4 (Current Procedural Terminology)
Which codes are more important to us and why?
CPT-4 codes because these are our billing codes
What is required to receive payment?
CPT-4 codes
Where are most PT related CPT codes located?
97000, “Physical Medicine and Rehabilitation”
Can a provider bill any code so long as they can legally render that service according to state licensure laws?
Yes
What is the 8-minute rule?
In order to bill for 1 unit of treatment, the time must be between 8 and 22 minutes.
What are the specific times for:
- 1 unit
- 2 units
- 3 units
- 4 units
- 5 units
- 8-22
- 23-37
- 38-52
- 53-67
- 68-82
Do most physical therapists under or over bill? What does this result in?
Most PTs under bill (and use wrong codes), which results in getting underpaid
What matters when performing a test and billing for said test?
Why you are doing that test, could fall under multiple codes.
What is the difference between a therapeutic exercise and a therapeutic activity?
- Therapeutic exercise only involves one parameter such as flexibility.
- Therapeutic activity involves multiple parameters such as adding strength to flexibility. This makes therapeutic activity more functional.
What should documentation for therapeutic exercise typically include?
Things such as:
-objective loss of joint motion, strength, mobility
