Primary Care Coding Alert

Question: We recently hired a physical therapist. He saw a 65-year-old male with multiple healed finger fractures on his left hand and treated him with the following:

- 20 minutes of fluidotherapy

- 20 minutes grade-2 mobilization to the MPs, PIPs, and DIPs of fingers 2-4

- 15 minutes of range-of-motion and strengthening exercises

.
Oklahoma Subscriber

Answer: The total time of time-based skilled interventions provided in this scenario is 35 minutes. The time-based therapeutic procedures are the joint mobili-zations and range-of-motion/strengthening exercises.

Fluidotherapy is a dry whirlpool containing crushed corn husks, which increases the circulation by increasing heat in the tissues. It also increases range of motion. You should bill it under 97022 (Application of a modality to one or more areas; whirlpool).

This modality is a service-based intervention, and you should not include the minutes spent providing this service in the total minutes when determining the number of time-based units you can bill.

You would automatically bill one unit of 97022 regardless of the amount of time spent providing the fluidotherapy, assuming it was medically necessary and met all other requirements.

According to CMS Program Memorandum AB-00-14, you should not report any timed therapy service that lasts less than eight minutes. To bill additional therapy units, the therapy session has to go at least eight minutes into the next 15-minute increment. 

Based on this -eight-minute rule,- 35 minutes falls between at least 23 minutes but less than 38 minutes. This allows you to report two units of time-based CPT codes. The correct billing in this scenario would be one unit of 97022, one unit of 97110 (Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility), and one unit of 97140 (Manual therapy techniques [e.g., mobilization/manipulation, manual lymphatic drainage, manual traction], one or more regions, each 15 minutes).

Note: If you would like us to e-mail or fax you a chart that breaks down Medicare's eight-minute rule for physical therapy coding, please e-mail our editor, Torrey Kim, at torrey@medville.com.