Coding Cues: Billling for physical therapy services

June 20, 2008

Our pain management group is considering a merger with a profitable two-provider physical therapy practice. Before moving ahead, we have two concerns. First, how would we report the PTs' services? Second, the practice's charges are well above the national average--a fact the PTs attribute to hard work, long hours, and multiple locations. Should we be concerned?

Key Points

Our pain management group is considering a merger with a profitable two-provider physical therapy practice. Before moving ahead, we have two concerns. First, how would we report the PTs' services? Second, the practice's charges are well above the national average-a fact the PTs attribute to hard work, long hours, and multiple locations. Should we be concerned?

First, the coding question: Typically, licensed physical therapists provide services using PT codes 97001-97002 for the workup and evaluation, plus 97010-97028 for the various modalities administered. Each therapist would bill for his own services using the correct codes and his own NPI, attached to the physician corporation's tax ID.

Regarding the unusually high charges, I'd suggest you investigate how their services are administered. If there are only two PTs and multiple sites, it's not possible for them to work at all locations all day, every day. If they're employing physical therapy assistants to provide unsupervised services at other sites, the PTs may be billing inappropriately, at least to Medicare: CMS requires direct supervision by a licensed PT, a physician, a PA, or an NP.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.