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Family Practice Coding Alert

Watch the Clock to Determine Physical Therapy Units

Experts crack 97032-97124's time requirements To rack up the right number of physical therapy units, you should bill using the "Eight-Minute Rule" and the predominant modality.

Billing physical therapy sessions "has been confusing for a lot of coders," due to the codes' time and unit requirements, says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.

Discover the secrets behind modality and therapeutic procedures time allotments. Learn Top-4 FP Therapy Codes Four physical therapy codes rank in the top-50 procedures family physicians perform. You should use these codes when a family physician (FP) or physical therapist (PT) provides electrical stimulation (97032), ultrasound therapy (97035), therapeutic exercises (97110), or massage therapy (97124):
  97032 - Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes
  97035 - Application of a modality to one or more areas; ultrasound, each 15 minutes
  97110 - Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
  97124 - Therapeutic procedure, one or more areas, each 15 minutes; massage, 
including effleurage, petrissage and/or tapotement (stroking, compression, percussion). Bill One Unit for 8- to 22-Minute Session Even though the physical therapy codes' descriptors refer to "each 15 minutes," don't assume you should bill one unit per 15-minute period. "You need at least eight minutes of therapy before you may code one unit," says Wanda L. Alger, CPC, CCP, senior coding consultant at Group Health Cooperative in Spokane, Wash.

Tip: You should code two units starting at 23 minutes until you reach 37 minutes. For billable intervals, see the chart later in this issue.

Learn the '8-Minute Rule'
 
"When you code the constant-attendance modalities (97032, 97035) or direct one-on-one therapeutic procedures (97110, 97124), the 'Eight-Minute Rule' applies," says Pauline Watts, PT, president of Encompass Consulting & Education in Pompano Beach, Fla. To bill a PT unit, the therapy session "has to go eight minutes into the next 15-minute" increment.

Example: An FP-employed PT provides physician-ordered ultrasound therapy (97035) for a patient's cervical neck spasm (728.85, Spasm of muscle).   You'd bill one unit of 97035 if the session lasts from eight to 22 minutes.
  To bill two units of 97035, the session would have to go eight minutes into the next 15-minute increment or last a total of at least 23 minutes (15 minutes in first increment + 8 minutes of second increment = 23 total minutes or 97035 x 2 units.) Add Different Therapy Times Together If you bill multiple PT codes on the same day, report the sum of the sessions' minutes. "You add the total minutes for each code," Watts says.

How to tally time: At an FP's office, a PT performs nine minutes of electrical stimulation, 18 minutes of therapy [...]