Most physical therapists chose this profession to help people—not to become the world’s greatest biller. And yet, in order to stay in business long enough to truly make a difference for your patients, you’ve got to know how to make a profit—and that requires a solid understanding of PT billing.
Adopting a top-notch EMR with a fully integrated billing software can make a huge difference in the success of your practice
Of course, you got into physical therapy to help people—not to rake in the dough. But in order to do the former well, you’ve also got to know how to make a profit—and that requires billing for your services. If you’re new to physical therapy, you might be feeling a little overwhelmed by the prospect, so here are a few things to remember about billing for physical therapy services—the basics, if you will.
Like the many Land Before Time sequels, the versions of our ICD-10 FAQ keep on-a-comin’. But—unlike those beloved dinosaur tales—I don’t anticipate 12 more versions (plus a TV series) will be necessary to cover what’s to come with ICD-10. Still, the questions continue to roll in—albeit a bit slower than they did a couple of months ago. However, most of the inquiries we’ve received in recent weeks have been super specific. That’s why, our most recent webinar—the ICD-10 Open Forum—included an extended audience Q&A session hosted by Dr. Heidi Jannenga and compliance expert Rick Gawenda. In case you missed it, I’m going to make like Littlefoot and take on some of our most frequently questions from the webinar while chewing on some prehistoric ferns (or something like that):
Where do I find information on state regulations related to ICD-10?
We suggest contacting your payers, as well as consulting your state association’s website/state practice act, to get the most up-to-date, state-specific information.
What’s the difference between R53.1, Weakness, and M62.81, Muscle weakness (generalized)?
According to this resource, M62.81 is typically classified as a disorder characterized by a reduction in the strength of muscles in multiple anatomic sites, or a reduction in the strength of muscles in multiple anatomic sites. R53.1, on the other hand, is a sign or symptom associated with:
- weakness and diminished or absent energy and strength;
- debility, or lack or loss of strength and energy;
- physical weakness, lack of strength and vitality, or a lack of concentration;
- lack of physical or mental strength;
- liability to failure under pressure or stress or strain;
- weakness; and/or
- lack of energy and strength.
If I shouldn’t use unspecified codes, then why are they even an option?
The unspecified codes exist in case there truly is not another, more specific option available. However, if a more specific option is available, you absolutely should use it.
If a patient experiences muscle weakness in a specific area, should I use M62.81?
The clinical description for M62.81 reads, “A disorder characterized by a reduction in the strength of muscles in multiple anatomic sites.” Because this code describes weakness in multiple anatomic sites, it would not be appropriate for weakness that exists in a specific location. As mentioned in our other FAQs, if available, you should always code for the underlying condition causing the muscle weakness first.
Can I list a condition like poor balance as a primary diagnosis?
You should code first for the underlying condition (i.e., what’s causing the patient’s balance issues). If you can’t determine the underlying condition, ICD-10 code R26.81, Unsteadiness on feet, might be a good option.
What code should I use for difficulty walking? R26.2 or R26.89?
Depending on your evaluation, you might discover the reason behind the disordered movement is best described by one code more than the other. Each code has its own synonyms that can help you make your selection.
For example, this resource explains that the description synonyms for R26.2, difficulty walking are:
- Difficulty walking
- Walking disability
The description synonyms for R26.89, Other abnormalities of gait, and mobility are:
- Cautious gait
- Gait disorder due to weakness
- Gait disorder, painful gait
- Gait disorder, weakness
- Gait disorder, postural instability
- Gait disorder, multifactorial
- Toe walking and toe-walking gait
- Limping/limping child
Should I code for accidents/incidents that affected my patients in the past?
You cannot—and should not—code for what you don’t know. If you can’t say for certain that the accident/incident directly correlates to the patient’s current condition, don’t code for it.
What if I have a highly-specific clinical coding question, and I can’t find the answer?
We’re happy to answer your questions to the best of our abilities. However, if the example is extremely clinical in nature, we can’t give you a definitive answer. But, we do know of a resource exactly for these types of situations. If you are able to supply supporting documentation for your particular scenario, you can submit your coding questions via this AHA portal.
How does WebPT protect providers from making ICD-10 coding errors?
WebPT prompts users to select the most complete code possible and does not allow users to bill incomplete codes. However, you’ll still need to use your clinical judgement to make the proper selection from all of the available codes.
Will WebPT allow providers to use ICD-9 codes for patients with dates of service prior to October 1?
Yes. WebPT automatically recognizes whether the patient should have ICD-9 or ICD-10 codes based on the date of service on the note.
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.
October 1—the day that marked the transition to ICD-10—is behind us; we made it. And so far, so good. According to this Modern Healthcare article: “One of the most maligned and feared events in healthcare history began with a whimper.” Although ICD-Day has come and gone, it’s prudent to remember that a “whimper” of an introduction doesn’t necessarily indicate what’s to come.
Relying on ICD-10 cheat sheets could spell disaster for your physical therapy clinic. Here’s why.
By now, it’s obvious that the entire US healthcare system is going to face a huge change come October 1: the transition to ICD-10. This new—well, new to us—way of coding has been on the discussion table for decades, and for the last several years, its implementation has been the topic of much anticipation as well as a fair amount of resistance. So, if you find yourself in the dark—completely unaware that ICD-10 is happening—then frankly, there really are no excuses for your ignorance or your lack of preparedness.
Imagine you’re playing a game. More specifically: an ICD-10 Rube Goldberg-style game. To win, you have to scurry through a series of stages without getting caught in costly traps. But what happens when you find yourself at the mercy of the swiftly-turning plastic crank? Before you know it, the cage has lowered and you’re out of the game—forever separated from your cheddar.
At this point, the majority of physical therapy clinics are using some type of software to document, schedule, and bill for patient treatment. Thanks to ever-increasing compliance regulations, paper had to go the way of the VHS, becoming nearly obsolete. When your practice switched from paper to software, it was a big change.
When it comes to ICD-10, physical therapists must code for medical necessity or risk claim denials.