Primary Care Coding Alert

Don't use 97110 as a one-size-fits-all exercise code

Do you know what provider contact 97032, 97035, 97110 and 97124 require? If not, you may be coding physical therapy incorrectly.

Family physicians (FPs) billed electrical stimulation, ultrasound, therapeutic exercises and massage more than 75,000 times in 2000. This frequency placed 97032 (Application of a modality to one or more areas; electrical stimulation [manual], each 15 minutes), 97035 (... ultrasound, each 15 minutes), 97110 (Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) and 97124 (... massage, including effleurage, petrissage and/or tapotement [stroking, compression, percussion]) in the top-50 most performed FP procedures, according to Medicare data.

Coders may not realize the unique requirements physical therapy codes contain. Follow our expert's physical therapy modalities and exercises reporting advice, and you can submit your claims accurately every time.

1. Memorize Two Basics

When reporting therapy codes, remember these fundamentals. Codes 97032, 97035, 97110 and 97124  require:

1. "direct one-to-one patient contact with the provider," says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. CPT classifies 97032 and 97035 as modalities that require constant attendance. And, a physician or therapist must provide direct interaction to report therapeutic procedures (97110, 97124).

2. time-based reporting in 15-minute increments. Use units to indicate session lengths. Bill one unit per 15-minute period, Hammer says.

Tip: The provider "must indicate one-to-one direct continuous contact" and the total time he spent in specific patient service, Hammer says. Doing so can help you avoid audit scrutiny.

2. Know State Provider Rules

Many family medicine coders next wonder who qualifies as a physical therapy provider. For the answer, look at two regulations.

First, CPT's therapeutic procedure notes state, "physician or therapist required." Therefore, 97110 and 97124 require that a physician or therapist perform the service, Hammer says.

A physical therapy assistant (PTA) also may provide therapy. But to bill the service, the encounter must "meet all the incident-to billing criteria," Hammer says.

Watch out: "Every state has its own requirements about who can bill the codes," says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky. Physicians can usually bill the therapy codes without a problem.

State laws, however, may restrict PTA procedures. A therapist must usually supervise the service, Corcoran says.

3. Bill Specific Modality, Exercise

When identifying a physical therapy service, you should code the specific modality or therapeutic exercise the provider performs.

Example: If your FP uses electrodes to stimulate a patient's muscle(s), report 97032 per 15-minute period. Make sure to switch to 97035 when the patient instead requires ultrasound.

Reporting 97032 for electrical stimulation and 97035 for ultrasound may seem like Coding 101. But coders often use one code as a catch-all.

Pitfall: Coders often mistakenly bill all exercise-related activities with 97110, Corcoran says. "But it's better to be specific."

"You should bill 97110 if your FP performs exercises with the patient," Corcoran says. But when the physician provides a more specific procedure, such as massaging a car-accident patient's injured neck, you should instead report 97124. Using this code tells the payer that the doctor performed massage.