While we’re about to close the books on 2016, we thought it would be nice—and educational—to look back on some of the therapy industry trends, advancements, and hot topics that made headlines throughout the year. Plus, most of these items will impact you and your practice in 2017 and beyond—so, as we look back, don’t forget to look forward. Okay, here we go!

New Year, New Codes: How to Bill for PT and OT Evaluations in 2017 - Regular BannerNew Year, New Codes: How to Bill for PT and OT Evaluations in 2017 - Small Banner

Clinical Trends

What are those weird suction cups all about?

If you, like many Americans, were glued to your TV during the 2016 Summer Olympics, then you definitely noticed something strange on the backs and torsos of all those elite swimmers—and Michael Phelps, the most decorated Olympic athlete of all time, was no exception. No, these large, red circles weren’t from leeches—but rather, marks resulting from cupping therapy, a therapeutic practice that involves using suction cups to increase blood flow to a patient’s muscles. And while it’s growing in popularity among athletes, cupping therapy also helps people cope with pain, persistent coughs, back problems, and conditions such as shingles. There are three popular variations of this therapy practice—which therapists can perform using either glass or plastic cups. They are:

  1. Wet Cupping: The purpose of this technique—also commonly referred to as Chinese bloodletting—is to remove “stagnant” blood from the patient’s body. The therapist applies cups to an impacted area of the patient’s body and then removes them after a few minutes. The clinician then makes small incisions and reapplies the cups, drawing blood into them.
  2. Dry Cupping: The purpose of this technique is to improve blood flow and facilitate faster healing. Unlike wet cupping, though, dry cupping doesn’t involve any incisions, so there shouldn’t be any blood leaving the body. The cups used for this practice—which range from one to three inches in diameter—are applied to the skin before suction is applied.
  3. Fire Cupping: The purpose of this technique is to treat respiratory diseases, like the common cold, pneumonia, and bronchitis. It’s also a form of deep tissue massage. To treat these common maladies, therapists first soak a cotton ball in isopropyl alcohol, light it on fire, and then quickly dip it into an empty cup. The flaming ball is then removed before it’s applied to the patient’s skin.

The verdict is still out on whether this treatment has any real impact. Some experts view cupping as a simple healing agent—nothing more. “The studies are very preliminary [on cupping]. We cannot say it has proven its efficacy,” said Romy Lauche, a scientist at the University of Duisburg-Essen in Germany.

Is dry needling a safe therapy practice?

The 4-1-1 on Dry Needling

Using needles in rehab therapy may seem antithetical to traditional patient care—after all, therapists pride themselves in providing noninvasive treatment. But, like cupping, dry needling is a form of therapy that grew in popularity in 2016. So, what is it exactly? Dry needling helps treat myofascial pain through the use of a dry needle that goes through the patient’s skin and into muscles in particular areas known as trigger points. Pro-needling therapists tout the practice’s many benefits—which include reduced pain and improved range of motion.

A Pointed Debate

Now, dry needling shouldn’t be confused with acupuncture, as the two treatments differ greatly. But, unlike acupuncture, dry needling has roused a heated debate in the rehab therapy community. Some states have even gone so far as to ban therapists from performing the practice altogether (click here to find out which states do and do not allow dry needling).

Some Workarounds for PTs

But even if you’re legally allowed to provide dry needling, you may still run into some hurdles. Chief among them: Some third-party insurers won’t reimburse for the service, claiming the treatment is “experimental.” Furthermore, the American Medical Association (AMA) has not yet developed a CPT code for the treatment. According to the APTA, “there is no CPT code that describes dry needling nor do any of the existing CPT codes include dry needling techniques in clinical vignettes utilized by [the American Medical Association] AMA in their process to establish relative value units.” Quite the bummer, indeed. So, what are some potential workarounds for rehab therapists looking to provide this service? We recommend asking your payers whether they’ll pay for this service and, if so, which CPT code you should use to bill for it. You also could provide this service on a cash-pay basis and thereby wash your hands of any potential denials entirely.

New Regulations

How do therapists use the new evaluation CPT codes?

As you’re no doubt aware (well, hopefully), come January 1, 2017, rehab therapists must begin using a new set of CPT codes when billing for any patient evaluations or re-evaluations. It’s a topic that garnered plenty of attention throughout 2016—and WebPT just so happened to hold a webinar on these important, looming changes (you can watch a recording of the presentation here). So, start saying your goodbyes now, because after New Year’s Eve, 97001, 97002, 97003, and 97004 are no more. In their place will be a brand new set of CPT codes that are tiered according to complexity. Bear in mind that this change applies to all HIPAA-covered entities and virtually all insurance carriers—not just Medicare. So, there’s no skirting this one.

With this in mind, I would highly encourage you to check out this blog post and this one, both of which offer complete, detailed information on the new CPT codes, including an explanation of how to select the right level of code complexity. I know—this extra legwork may not be a picnic from the outset. However, as we continue to hammer home, the long-term payoff is that you’ll eventually be able to create clearer snapshots of the patients you treat and the care you provide—which could have a more positive effect on future reimbursement rates.

Are therapists really off the hook for PQRS?

The short answer: yes. Medicare released its Final Rule in November and indicated that PQRS is officially no more at the conclusion of 2016. That means that as of January 1, 2017, you’re relieved of your quality reporting duties—sort of (more on that later). Under PQRS, all eligible Medicare providers—including PTs, OTs, and qualified SLPs—had to meet the criteria for satisfactory reporting of certain outcome measures. And although PQRS was never technically mandatory—and, believe us, we received plenty of questions about this throughout 2016—eligible providers (EPs) who didn’t satisfactorily meet reporting requirements were subject to financial penalties. Now, just because PQRS will cease to exist in the new year doesn’t mean EPs are off the hook for any penalties they incurred in previous reporting years. So, if you failed to report satisfactorily in 2015 or 2016, you’ll still suffer a 2% downward payment adjustment on all Medicare Part B payments in 2017 or 2018, respectively. But, as I mentioned above, the elimination of PQRS doesn’t necessarily mean the end of your quality reporting duties—at least not in the long term.

How do therapists continue reporting quality data?

While PQRS is going away, many elements of PQRS will live on as part of the new quality reporting program known as the Merit-based Incentive Payment System (MIPS), which goes into effect January 1, 2017. I can already hear the groans: “You mean there’s another quality reporting program already on the books?!” Well, yes. But, don’t get your tinsel in a tussle just yet. As we previously reported, while PTs, OTs, and SLPs aren’t formally required to join the program until at least 2019, CMS will allow non-eligible providers to participate in MIPS on a voluntary basis during the 2017 and 2018 reporting years. So, if you want to maintain continuity in your quality data-reporting habits, it appears you’ll have the option to do so. Unfortunately, that’s about as much as anyone knows at this point, as CMS has yet to formalize any details on voluntary MIPS participation. Of course, as soon as we know those details, we’ll post them right here on the WebPT Blog.

Is the ICD-10 grace period really over?

A major theme throughout 2016—and one that will certainly carry over into 2017 and beyond—is providers’ duty to always select the most specific diagnosis codes available to support the medical necessity of their services. Coding decisions can sometimes turn into head-scratchers, and providers who were still struggling one year post-transition may have experienced additional difficulty when Medicare’s ICD-10 grace period ended. That period—which began when ICD-10 went into effect on October 1, 2015—officially ended on October 1, 2016 (i.e., ICD-10’s one-year anniversary).

The Dwindling Margin for Error

While the grace period allowed for some coding wiggle room, Medicare and other payers have become less forgiving following the one-year mark. As such, PTs, OTs, and SLPs can no longer expect payment for merely selecting a code from the proper family of codes (a “family of codes” refers to a group of codes falling under the same three-character category). In other words, providers are now subject to the full scope of ICD-10 coding requirements—and that means they must accurately code to the greatest possible level of specificity. Otherwise, they risk claim denials.

The Demand for Specificity

We hate to sound like a broken record, but we cannot emphasize enough the need to code for true, unadulterated specificity. CMS won’t be shy about rejecting your claims. That means you must not only consistently select the most specific code possible, but also ensure your documentation supports your coding decisions—especially if you have to use an unspecified code. On that note, keep in mind that reporting unspecified codes won’t always lead to claim denials. In fact, there are some situations in which reporting unspecified codes is 100% acceptable or even “necessary”—such as “when sufficient clinical information is not known or available about a particular health condition to assign a more specific code.” When in doubt, though, it never hurts to ask—because getting paid for any services you perform is kind of a big deal. And continuing with the theme of specificity, one last note: CMS recommends that providers focus mainly on the codes that affect their practices as well as the clinical concepts behind those codes.


Depending on who you ask, 2016 was kind of a bummer—countless celebrity deaths and non-stop election coverage, anyone?—and many people, quite honestly, can’t wait for 2017. But that doesn’t mean we, collectively, didn’t learn a lot about important industry changes and how to navigate them. Indeed, the end of each year offers a great time for introspection and brainstorming on how we can make the future even brighter. Cheers to a happy and prosperous 2017!

What new industry advancements or regulations caught your eye in 2016? How will some of these changes impact you moving forward? Leave your thoughts in the comment section below.

  • The Ultimate ICD-10 FAQ: Part Deux Image

    articleSep 24, 2015 | 16 min. read

    The Ultimate ICD-10 FAQ: Part Deux

    Just when we thought we’d gotten every ICD-10 question under the sun, we got, well, more questions. Like, a lot more. But, we take that as a good sign, because like a scrappy reporter trying to get to the bottom of a big story, our audience of blog readers and webinar attendees aren’t afraid to ask the tough questions—which means they’re serious about preparing themselves for the changes ahead. And we’re equally serious about providing them with …

  • The Complete PT Billing FAQ Image

    articleMay 24, 2016 | 25 min. read

    The Complete PT Billing FAQ

    Over the years, WebPT has a hosted a slew of billing webinars and published dozens of billing-related blog posts. And in that time, we’ve received our fair share of tricky questions. Now, in an effort to satisfy your curiosity, we’ve compiled all of our most common brain-busters into one epic FAQ. Don’t see your question? Ask it in the comments below. Questions related to: • WebPT • Modifier 59 • Other Modifiers • Coding • ICD-10 • …

  • Dawn of the ICD-10: Life in the Post-Transition World Image

    articleOct 28, 2015 | 5 min. read

    Dawn of the ICD-10: Life in the Post-Transition World

    Some of you might remember all of the hype around Y2K. Rumors and speculation were abuzz, and there were people who thought all hell was going to break loose when the clock struck midnight on January 1, 2000. And then—dun, dun, dun—nothing happened. The Hyperbolic Hype The lead-up to October 1 was similar in many respects, albeit on a much smaller scale. People all over the healthcare community were freaking out about the unknown; some large practices …

  • ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs Image

    webinarSep 2, 2015

    ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs

    It’s officially here: the last month before all HIPAA-eligible professionals must switch to the ICD-10 code set. As the regret of procrastination washes over many of those professionals, they’re scrambling to ready themselves and their practices for the big switch. If you, like so many other rehab therapists, find yourself asking, “ICD-what?” then you’re in dire need of straightforward training—stat! Otherwise, you could leave your practice vulnerable to claim denials after October 1. Join us at 9:00 …

  • Last Legs: The Compliance Vulnerabilities of Dead or Dying Software Image

    articleOct 24, 2016 | 5 min. read

    Last Legs: The Compliance Vulnerabilities of Dead or Dying Software

    Rusty mechanical equipment. Creaky carnival rides. Wobbly chairs. People are naturally skeptical of things that are dilapidated, rundown, or slipshod—and with good reason. After all, that which is ramshackle usually isn’t reliable. Now, imagine it’s the physical therapy software you use everyday to run your rehab therapy practice that’s gone derelict. Take PTOS EMR, for example , because if you didn’t know, this therapy office software is going out of business, and it has ceased all updates …

  • The PT's Guide to Billing Image

    downloadJun 7, 2016

    The PT's Guide to Billing

    When it comes to physical therapy billing, you have to know your stuff—because even the simplest mistakes can cause denials. Of course, knowing billing backwards and forwards doesn’t have to be complicated. That’s why we created a comprehensive billing resource specifically for PTs. Take the guesswork out of billing. Enter your email address below, and we’ll send your free guide.

  • The Ultimate ICD-10 FAQ Image

    articleSep 1, 2015 | 20 min. read

    The Ultimate ICD-10 FAQ

    Yesterday, we hosted the largest webinar in WebPT history. Thousands of rehab therapy professionals attended the live session, which focused on ICD-10 coding examples . As expected, we received a lot of questions. Below is a collection of the webinar’s most frequently asked questions. The Seventh Character Craze What is the seventh character? The seventh character didn’t exist in ICD-9, so it’s caused a great deal of confusion. Essentially, it’s a mechanism for applying greater specificity to …

  • Your Roadmap to ICD-10 Image

    articleOct 10, 2013 | 5 min. read

    Your Roadmap to ICD-10

    By now you’ve already—hopefully—heard the news about the big ICD-10 transition that’s going down on October 1, 2015. But, if you’re like most US healthcare providers—about 75%, according to this article —you haven’t exactly stuck to the suggested preparatory timelines that CMS released a while back. We get it; you’re busy, and the last thing you have time for is sitting down and mapping out a plan of action for your clinic’s transition to ICD-10. But putting …

  • ICD-10 Open Forum Image

    webinarOct 5, 2015

    ICD-10 Open Forum

    On October 1, the US officially said RIP to ICD-9 and brought ICD-10 to life. For some of you, the transition might’ve been all sugar and spice—a real treat. But for many others, the switch to the new code set might’ve left you feeling overwhelmed, tricked, or even a bit scared. At the very least, you might be haunted by some lingering questions. That’s where we can help. We’ve brewed a cauldron filled to the brim with …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.