Many clinic managers find that errors in billing for physical therapy treatment is one of the most frustrating tasks for a private practice owner. Despite the hassles caused by trying to determine the right physical therapy billing codes for each patient, understanding the coding and billing process are very important parts of not only helping your clinic perform well financially, but also providing the best possible service to your patients. For those who are working solely from the perspective of a working physical therapist, this is especially true. Clinicians who are managers in a private practice often have limited experience with physical therapy billing software and practices. However, there are a few basic concepts that will make understanding physical therapy billing codes a little easier.
The most difficult part of physical therapy billing codes is determining which codes are most appropriate for billing purposes. In order to get the fastest and highest reimbursement from insurance companies and Medicare/Medicaid, you must choose highly specialized codes in relation to the diagnosis for which you are treating the patient. Mistakes made in determining the best physical therapy billing codes cost practices thousands of dollars each year when third party payers deny claims that have been submitted.
Physical therapy billing codes will vary based on the diagnosis for which the patient was referred to you. When determining the correct codes for billing after service, you must charge the insurance company for the exact same condition that the patient originally came to you for. Physical therapy cpt codes for evaluation and treatment are listed in the ICD-9-CM.
This is also known as the International Classification of Diseases code manual. You can purchase a copy of these manuals through the publisher, Ingenix, or you can purchase physical therapy billing software which contains this information.
Once you determine the physical therapy billing billing codes associated with patient diagnosis, you must then determine which codes are appropriate for the physical therapy services you have performed.
The most commonly used billing codes for physical therapy private practices are determined using the CPT-4 codes, which were developed by the American Medical Association (AMA). The physical therapy billing codes for each session will be unique to the services performed during that particular visit.
Even though you have sent a bill to a third party payer, you may not always be approved for reimbursement. Most clinics choose to use physical therapy billing software to assist them with preparing and filing claims and managing physical therapy billing codes. Claim forms created using physical therapy billing software can either be printed or sent electronically. While physical therapy billing codes are assigned by the software, ensuring that your staff has a basic understanding of codes will help minimize mistakes. Submitting claims using physical therapy billing software often results in faster and more accurate reimbursement, making the physical therapy billing process far less stressful for providers and staff. You will find that you quickly recoup the costs of training and physical therapy billing software through an increase in successful, quick, and complete payments for services in your practice.