Referencing a Codes That Matter study, CMS developed a breakdown of common codes based on specialty and released it with the following two warnings:
- “The codes most frequently used by your practice will vary based on geographic location, patient population, payer mix, and other differentiating factors.”
- Even though this study shows unspecified codes as being common, practitioners should absolutely (positively, definitely) consider codes that have a greater degree of specificity first and foremost.
Without further ado, below are the common codes associated with PT, according to CMS. (I took the liberty of removing the unspecified codes for those that allow specific laterality.)
| Pain in Joint | |
| M25.511 | Pain in right shoulder |
| M25.512 | Pain in left shoulder |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
| M25.532 | Pain in left wrist |
| M25.551 | Pain in right hip |
| M25.552 | Pain in left hip |
| M25.561 | Pain in right knee |
| M25.562 | Pain in left knee |
| M25.571 | Pain in right ankle and joints of right foot |
| M25.572 | Pain in left ankle and joints of left foot |
| M25.579 | Pain in unspecified ankle and joints of unspecified foot |
| M25.50* | Pain in unspecified joint |
| Pain in Limb | |
| M79.601 | Pain in right arm |
| M79.602 | Pain in left arm |
| M79.604 | Pain in right leg |
| M79.605 | Pain in left leg |
| M79.609 | Pain in unspecified limb |
| M79.621 | Pain in right upper arm |
| M79.622 | Pain in left upper arm |
| M79.631 | Pain in right forearm |
| M79.632 | Pain in left forearm |
| M79.641 | Pain in right hand |
| M79.642 | Pain in left hand |
| M79.644 | Pain in right finger(s) |
| M79.645 | Pain in left finger(s) |
| M79.651 | Pain in right thigh |
| M79.652 | Pain in left thigh |
| M79.661 | Pain in right lower leg |
| M79.662 | Pain in left lower leg |
| M79.671 | Pain in right foot |
| M79.672 | Pain in left foot |
| M79.674 | Pain in right toe(s) |
| M79.675 | Pain in left toe(s) |
Want to view all the common codes? Check out the full list here. Keep in mind that this list is inherently limited because for therapy, it focuses predominantly on pain, even though you should always code for the underlying condition that is causing the pain whenever possible. What codes do you think are most common in your practice?
