E/M Coding for PT Evaluations
Physical therapy evaluations (CPT codes 97161-97163) are tiered based on complexity. A low-complexity evaluation (97161) involves a straightforward history with no personal factors. A high-complexity evaluation (97163) involves a patient with multiple comorbidities and a complex history. Your documentation must clearly support the level of complexity you bill for, detailing patient history, examination findings, and clinical decision-making.
Billing for Manual Therapy and Joint Mobilization
Manual therapy (CPT 97140) is a time-based code billed in 15-minute increments. It covers techniques like joint mobilization, soft tissue mobilization, and manual lymphatic drainage. It is crucial to document the specific techniques used, the anatomical location, and the time spent on each to justify the number of units billed. Vague documentation is a common reason for denial.
Coding Therapeutic Exercise and ROM
Therapeutic exercise (CPT 97110) is one of the most common codes in physical therapy. It covers exercises for strength, endurance, and range of motion (ROM). Like manual therapy, it is a time-based code. Your notes must specify the exercises performed, the purpose (e.g., "to increase quadriceps strength"), and the total time spent to support the units billed.
The 8-Minute Rule: For Medicare and many other payers, you must provide at least 8 minutes of a time-based service to bill one unit. Be sure to understand and correctly apply this rule when calculating total billable units for a session.
