The medicare system in the USA in particular and in the world, in general, has become complex. Now it involves not only the patient and the medical facility but also the third party. The third party here is the insurance company, which reimburses the amount of treatment given by the medical facility, whether it is a hospital or a clinic.
Physical therapy billing services
Physical therapy billing services are those third party entities which are specialized in physical therapy billing. These services handle all steps of invoice in physical therapy procedures.
What are the procedural codes?
Now the medical billing cycle starts with a patient being registered for treatment. When the doctor sees the patient and identifies his problem or injury, the billing staff person generates diagnostic codes. These codes explain what problem or damage (in case of physical treatment) the patient is having. After that, the doctor gives the patient its necessary treatment. After the procedure, the procedural codes are assigned. These codes translate the level of treatment provided to the patient. The procedural codes are divided into six sections
- Evaluation and management
- Pathology and Lab
These procedural codes must coincide with the diagnostic codes generated earlier. If they don’t, it can delay the payments on in some cases. The claim of the hospital or medical facility is rejected altogether, which is not suitable for the medical facility. The two central procedure coding systems are as follows
- Current Procedural Terminology(CPT)
- Health Care Common Procedure Coding System
These procedural codes are globally recognized, and different institution publishes them. In the USA, the institute known as the American Medical Association maintains the CPT system. Each year this institute publishes the updated version of this coding system in the form of manual, which includes CPT codes and guidelines on how to use these codes correctly. To understand procedure codes in detail, we will see some examples of procedure codes for physical therapy.
Physical Therapy CPT codes
- 97110: Therapeutic exercise
- 97112:Neuromuscular Re-Education
- 97116:Gaint Training
- 97140:Manual Therapy
- 97761:Prosthetic training
Explanation of some codes
97110 Therapeutical practice: This is a procedure that helps the patients to prevent physical impairments of the body by making them systematically do plan physical exercise.
97140 Manual therapy: This is the most used procedure in physical therapy procedures. It is one of the oldest methods. It includes all activities of physical treatment to treat musculoskeletal pain and disability. The physical therapist uses different exercises to treat patient limitations and illnesses. These exercises manipulation of muscles, joint mobilization, and joint manipulation.
Procedural codes are essential in the billing cycle. They translate the treatment given by the doctor into monetary terms. They must be used very carefully if, in any way, they don’t match with diagnostic codes; it will create problems for the doctor and the medical facility. Now hospitals can outsource this procedure to save them from billing problems.