Physical Therapy (PT) Billing CPT Codes

The Current Procedural Terminology codes or CPT codes are used to code medical and surgical procedures in order to maintain the medical records, health insurance procedures, and to provide statistical information. The CPT codes are categorized as follows:

1. CPT Codes – Category I

These codes are comprised of five-digit numerical codes that encode the medical and surgical procedures performed by qualified health professionals.  

2. CPT Codes – Category II

These are also known as the ‘performance measurement codes’ and comprise numbers and alphabets. The category II codes determine the quality of the treatment.

3. CPT Codes – Category III

These codes are composed of numbers and alphabets. Category III codes are used for collecting data and analyzing new technologies, services, and procedures. Once justified, the codes are placed in category I of CPT codes. If not accepted in category I, the codes remain viable for five years. [1]

CPT Codes vs. ICD-10 Codes

International Classification of Diseases – Tenth Edition (ICD-10) codes are part of the healthcare coding system, and are used to describe the health conditions for which the treatment procedures are administered. The ICD-10 codes are made of seven characters, comprising both alphabets and numbers. This includes the subjective and objective presentation of a patient, examination by a physician, and the diagnostic tests performed. [2] In simpler words, ICD-10 codes are called the diagnosis codes, whereas, CPT codes are known as the procedure or treatment codes. For instance:

1. ICD-10 Code: M1A.0120 indicates chronic gout of the left shoulder with an absence of tophus, caused by renal impairment. [3]
2. CPT Code: 58210 specifies extensive hysterectomy or removal of the uterus. [4]

Physical Therapy and CPT Codes

Physical therapy is a medical subspecialty that involves the analysis, examination, and treatment of individuals who are suffering from impaired physical functions. Physical therapy restores the range of movement, assists in rehabilitation, and plays a significant role in the prevention of health conditions. [5]

CPT codes used to evaluate physical therapy services are given in table 1. [6]

Physical Therapy CPT Codes for Virtual and Remote Treatment Services

With the rise in the number of individuals infected with the Omicron variant of the SARS-CoV-2 virus, the major services and activities are moving online. Concerning telemedicine, treatment modalities are billed according to the true telehealth services, congruent to the procedures performed in the clinic. However, certain temporary and emergency services require a separate billing system. The CPT codes for this billing system are given in table 2. [7] 

Column 1 and Column 2 of CPT Codes 

Column 1 CPT codes are payable. Column 2 CPT codes are only payable with the corresponding column 1 code if validated by a modifier. Examples of column 1 and column 2 code pairs are given in table 3. [8]

Modifier 59 and Physical Therapy CPT Codes

‘Distinct procedural services’ or the procedures, excluding emergency services, that are performed but not reported together, are identified by conjugating modifier 59 with the CPT code. Modifier 59 is among the several modifiers devised by the National Correct Coding Initiative (NCCI), used to identify procedures that shouldn’t be reported but billed collectively. Modifier 59 is applied when:

1. The procedures may not be performed on the same day
2. Procedure is performed on different organs or at different anatomic sites
3. Procedure performed on different anatomic regions of the same organ
4. Other modifiers are not applicable in defining the two procedures  

Example: Modifier 59 is reported with CPT code 76000 if the fluoroscopy is performed with a duration of 1 hour of the physician’s time and is not associated with cardiac catheterization. [9]

Conclusione

CPT codes are employed to facilitate the maintenance of medical procedures and the related costs – procedure bills, insurance claim, and epidemiological studies that require statistical information. The Centre for Medicare and Medicaid Services (CMS) has devised a list of CPT codes in order to encode for the treatment procedures performed. The CPT codes are five-digit numeric codes, with each numeral or a pair specifying a certain parameter – time, number of patients, and the procedure performed. Columns 1 and column 2 of CPT codes determine whether the procedure is payable or not as well as signify the types of modifiers that can be used with column 1 CPT codes. 

Riferimenti

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960170/ 
3. https://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M1A-
4. https://www.ncbi.nlm.nih.gov/books/NBK349622/table/sb200.t3/ 
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015533/
6. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56566&ver=24#h3HcpcsCodesHeader
7. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet 
8. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/how-to-use-ncci-tools.pdf 
9. https://www.cms.gov/files/document/proper-use-modifiers-59-xepsu.pdf