Along with ICD-10 is another term called CPT codes. Nitin Chhoda defines and differentiates these two terms, and explains the impact they will have on the whole physical therapy documentation process.
Practitioners must become familiar with the codes in order to minimize errors upon claim submissions.
Every procedure, task, service, device and surgery a patient receives is associated with a specific numerical code. Insurance companies utilize CPT codes to determine the amount healthcare providers will be paid and CPT codes must be linked by medical necessity.
The American Medical Association (AMA) develops and copyrights CPT codes. They’re responsible for changing, revising, updating and discarding those that become obsolete as new technology and treatments become available. They encompass thousands of individual codes that are updated annually.
CPT codes, even when used in physical therapy documentation purposes, are uniform and apply to all clients except those with Medicare coverage. Medicare utilizes the Healthcare Common Procedure Coding System (HCPCS) that encompasses three levels of coding.
HCPCS Level I is maintained by the AMA and Level II consists of alphanumeric codes. Level III codes were abolished in 2003 and were state-developed for Medicaid and Medicare contractors. Therapists should be aware that the reimbursement amount for each code varies widely among insurers and assigning the correct code to the appropriate treatment is a complex endeavor.
An EMR facilitates the process, but clinic owners will want to ensure their coding and billing expert has the best possible training to manage CPT codes and the upcoming ICD-10 changes, along with a thorough knowledge and understanding of medical terminology. Entering the wrong codes will result in denials and delays in reimbursements.
It’s imperative that physical therapists use the code that most accurately reflects the service or treatment that was provided. It should match the current ICD coding and therapists must provide sufficient documentation to support the CPT code that was entered to avoid denials, audits and requests for more information.
CPT codes allow for two-digit modifiers should they be required, but they must conform to standard definitions. Incorrect coding costs valuable clinical time, interrupts cash flow and can delay essential services to clients.
CPT codes provide the means for healthcare providers to communicate effectively with insurance companies about the services, treatments and procedures rendered to any given patient.
Using correct coding is essential if clinicians are to be adequately reimbursed for their expertise and ensures payments reach the clinic in a timely manner.
There is no uniform payment for specific procedures. Each insurance provider has its own fee schedule and reimburses according to the company’s guidelines. Proper coding ensures therapists are reimbursed at the highest possible level.
An EMR provides clinic owners with tools to monitor and track agencies that provide the best reimbursements, allowing them to make informed decisions about the best payers with which to contract.
The use of CPT codes in conjunction with ICD codes directly affects the profitability of practices. It’s a complex system that requires knowledgeable staff, careful attention to detail, and stringent documentation to support every diagnosis, treatment and procedure. An EMR makes the coding and billing process easier, and provides practice owners with the tools to track the best payers for increased revenues.