Let’s outline some of the common billing terminology. This is useful in order to understand how to effectively to use physical therapy CPT codes as well as to communicate with your biller, when necessary.
Untimed codes: When an untimed code is used, there is a predetermined fee for the session, regardless of the type of treatment, modality or the number of areas of the body being treated. This type of code can only be used once for an individual treatment and must not be included as part of billing calculations for timed treatment. This is separate from timed treatment. For example, if you plan to bill for a 60-minute session and if you use an untimed code for 15 minutes of the session. You would only bill for the remaining 45 minutes using a different code.
Timed codes: Timed codes are exactly what they sound like, these are billing codes that are used to bill for the actual time a practitioner spends with a patient as well as time for skilled interventions. These codes include time for pre-treatment, actual treatment and post-treatment. For example, if you plan to use this code for a 30-minute treatment session, you could bill for the entire session under this code.
Pre-treatment time: Assessment and case management are a necessary part of some physical therapy sessions. Physical therapists can bill for time taken to assess patient’s progress, evaluate the injury or muscle deficits or to analyse the approach to be taken during a treatment session under the preview of pre-treatment. Includes assessment and management, assessing patient progress, inspection of the tissue or body part, analysing results of the previous treatment, asking questions, and using clinical judgment to establish the day’s treatment. This can all be billed as contact time from the physical therapist or aide. With this code, if you spend 20 minutes performing manual muscle testing using a handheld dynamometer, this would be billed under pre-treatment time.
Intra-treatment time: This code refers to any time spent providing an intervention.
Post-treatment time: Time spent on each session to analyse a patient’s response to either an intervention, treatment or giving education or home exercise program. Post-treatment time can also include time spent on documenting the patient’s chart and/or consulting with other healthcare professionals about the patient’s care. The only caveat to this rule is that the patient must be present when these events occur in order to use this code. For example, if you spend 10 minutes explaining how to do exercises for the patient’s home exercise program, this could be billed as post-treatment time.
The 8-Minute Rule: The 8-minute rule is an important one to understand, because according to American Medical Association (AMA) guidelines, leftover minutes that fall into multiple categories with less than 8 minutes per category cannot be billed for. For example, if you spend 6 minutes providing manual therapy and 5 minutes providing ultrasound therapy. The codes must be totalled and billed for the treatment with the greater treatment time. This also works according to Medicare guidelines (8-Minute Rule), where you can combine this extra time (11 minutes total) into one additional unit of manual therapy since the sum of your remainders was more than 8 minutes (you bill for the service that you provided more of, hence, manual therapy in this case)