Primary Care Coding Alert

Bill One Unit for 8- to 22-Minute Session

Even though the physical therapy codes' descriptors refer to "each 15 minutes," don't assume you should bill one unit per 15-minute period. "You need at least eight minutes of therapy before you may code one unit," says Wanda L. Alger, CPC, CCP, senior coding consultant at Group Health Cooperative in Spokane, Wash.

Tip: You should code two units starting at 23 minutes until you reach 37 minutes. For billable intervals, see the chart later in this issue.

Learn the '8-Minute Rule'
 
"When you code the constant-attendance modalities (97032, 97035) or direct one-on-one therapeutic procedures (97110, 97124), the 'Eight-Minute Rule' applies," says Pauline Watts, PT, president of Encompass Consulting & Education in Pompano Beach, Fla. To bill a PT unit, the therapy session "has to go eight minutes into the next 15-minute" increment.

Example: An FP-employed PT provides physician-ordered ultrasound therapy (97035) for a patient's cervical neck spasm (728.85, Spasm of muscle).  

Add Different Therapy Times Together

If you bill multiple PT codes on the same day, report the sum of the sessions' minutes. "You add the total minutes for each code," Watts says.

How to tally time: At an FP's office, a PT performs nine minutes of electrical stimulation, 18 minutes of therapy and 10 minutes of massage. If you add the modalities and therapy minutes together, you have 37 physical therapy minutes that you should report.

Based on the "Eight-Minute Rule," you would bill only two physical therapy units.

Report Largest Modality First

For multiple therapy/modality sessions, you should assign units to the codes the PT performs longest. If you can only bill two units, you would allot one unit to each of the primary physical therapy codes.
 
Here's how: In the above PT encounter involving nine minutes of electrical stimulation, 18 minutes of therapy and 10 minutes of massage, you would bill one unit of therapy (97110) and one unit of massage (97124),  Watts says.

Don't do this: You should not bill any units of electrical stimulation. The chart note would identify the electrical stimulation, but due to the physical therapy time constraints, you would not report 97032, Watts says.

Editor's note: For the CMS physical therapy program memorandum, go to www.cms.hhs.gov/manuals/pm_trans/AB001460.pdf. 

Use Same Rules for All Insurers

Although Medicare issues the physical therapy time and modality allotment rules, coding experts recommend using these rules for all payers. "Since most carriers adhere to Medicare guidelines for documentation and coding, I educate my physical therapists to document all patient visits according to Medicare guidelines," Alger says. "It is actually easier for the therapist to document every visit the same, to the highest standard (MC)." 

Corcoran agrees with this advice, "Most of the PTs that I work with do use this criteria for all of their patients."