Category Archives: billing and coding

Documentation and Proper Billing of Physical Medicine and Rehabilitation Services

Modalities (e.g., heat, mechanical traction or ultrasound) are generally coded and billed based on the device that is used.

Therapeutic procedures are generally coded and billed on the basis of the intended outcome, not on a device or piece of equipment. For instance therapeutic exercise, 97110, is intended to increase strength, flexibility, and/or endurance while neuromuscular re-education, 97112, is to restore balance, coordination, proprioception, kinesthetic sense etc. The movement or activity can be very similar in these services and as a consequence the proper code to represent the service will depend on the outcome or purpose of the service.

When billing and coding for therapeutic procedures, document the intended clinical outcome, as well as how the procedure is performed. Bear in mind that the documentation should indicate a relationship to a functional improvement and activity as a result of care.

For example: Increase flexibility of the lumbar paraspinal muscles, while activating and stretching the hamstring muscles, to improve the patient’s capacity for walking and standing. This relationship can be easily documented as part of the subjective and objective sections of the chart notes.

Current Procedural Terminology (CPT)

Sometimes we get asked the difference between diagnostic (ICD) and CPT codes. Both codes sets are used to standardize medical communications across the board, but ICD codes focus on the diagnosis, whereas CPT coding identifies the services provided. Understanding how to properly use CPT codes is really critical in helping achieve prosperous reimbursement because insurance companies use these codes to determine how much an acupuncturist will be paid. The CPT section in AcuCode Digital Coding is a very helpful tool in helping not only select, but really understand the appropriate code to use. Digital Coding has three specific acupuncture CPT sections: evaluation and management; physical medicine and rehabilitation; and acupuncture. Did you know that misuse of a CPT code is the #1 trigger of an audit by an insurance company? All the more reason to make sure you are using the right code, the most updated code, and are knowledgeable how to apply CPT to an acupuncture practice.

ICD-10 Feet Dragging is the Norm

If you are still on the fence about ICD-10 coming to pass this October 1, 2015; you're in great company. Workgroup for Electronic Data Interchange finds that in a survey of over 1,100 physician players and vendors the biggest obstacle to industry readiness is the assumption that another delay will occur. In fact, we at Digital Coding were on the fence not too long ago also. With year-after-year of constant delays we don't blame anyone for dragging their feet on installing a transition plan. After carefully following lobbying efforts monitoring what the "big guys" such as medicare and the AMA are up-to, it seems that there is no longer enthusiasm for another delay, but rather a readiness for the transition to finally take place. Our friends at MedPage report that Barbie Hays, coding and compliance strategist for the American Association of Family Physicians says that "At this point it would need a presidential mandate for this to stop and I don't think that is going to happen." We certainly agree, and our own billing expert Sam Collins cautions to not wait until the last minute to devise your plan. The time is now to start looking at the new codes and getting your acupuncture practice in shape for the transition.