Medical Bill Coding
Dry Needling – The Code Dilemma
Billing for dry needling tends to bring up questions regarding code selection as there isn’t a code that specifically describes this procedure. Some publications advise using 97140 (manual therapy techniques) or 97112 (neuromuscular re-education) depending upon the purpose of the service. Others advise using 97799 (unlisted physical medicine/rehabilitation service or procedure) or 97139 (unlisted therapeutic procedure). Montana State Fund has determined that 97139 may be billed for dry needling services when billing Montana State Fund. NOTE: This is only a Montana State Fund recommendation and may be different from other carriers.
Physical Therapy Timed Codes
Time is an element of many physical rehabilitation modalities and procedure codes. When billing these services, time for each timed code must be documented in the record to support what is billed. If the time spent on a timed code is less than 8 minutes and is not the only timed service billed, then the time can be added to the total time to determine the number of units that can be billed:
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units etc
Note: Please bill for services provided – do not combine total time and bill for the highest reimbursed service only, this will result in a denial.
When more than one service of a timed modality is performed in a single day, the total minutes of the service performed should be included in the patient record to substantiate the level of service. A total of 8 units of active and passive therapy may be billed per visit. If active therapy is being applied, only two units of a passive modality may be included in the 8 units.
- Passive therapies (listed in U&T Guidelines) will be limited to 4 units per visit, if only passive therapy is being applied. Note: Only 2 units may be billed if active therapy is being applied.
- All timed codes must have the actual time spent documented (in minutes) in the office notes submitted for each code billed for reimbursement.
Therapy codes billed must have part of body documented or it must be clearly identified in a flow sheet or other attached documentation and must be related to the injury. If the procedures are clearly documented in the notes, a flow sheet is unnecessary. If the notes do not support the procedures billed but refers to a flow sheet, please include the flow sheet with the bill and other documentation.
Rule of Eights: Providers are allowed a total of 8 units of active/passive therapeutic procedures per visit with these exceptions:
- If active/passive therapeutic procedures are utilized:
- only 2 units may be a passive modality per visit.
- If only passive modalities and/or passive therapeutic procedures are being utilized, only 4 units
may be billed per visit.
NOTE: If a physical therapy/modality is not listed in the Utilization and Treatment Guideline (U&T) or goes over the maximum threshold, be sure to get pre-authorization.
|97010||Hot or cold packs – one or more regions|
|97012||Traction – mechanical|
|97014||Electrical stimulation (unattended)|
|97024||Diathermy (e.g. microwave)|
|97032||Electrical stimulation (manual) one or more areas, ea 15 minutes|
|97033||Iontophoresis, ea 15 minutes|
|97034||Contrast Baths, ea 15 minutes|
|97035||Ultrasound, ea 15 minutes|
|97036||Hubbard tank, ea 15 minutes|
|97039||Unlisted modality, specify type and time if constant attendance|
Active/Passive Therapeutic Procedures:
|CPT Code||Description||Passive or Active|
|97110||Therapeutic Procedure, 1 or more areas, ea 15 minutes. Therapeutic exercises to develop strength, endurance, range of motion and flexibility.||Active|
|97112||Neuromuscular re-education, ea 15 minutes||Active|
|97113||Aquatic therapy with therapeutic exercises, ea 15 minutes||Active|
|97116||Gait training (includes stair climbing), ea 15 minutes||Active|
|97124||Massage, ea 15 minutes||Passive|
|97139||Unlisted therapeutic procedure. ** Passive or Active will depend upon the procedure.||Passive or Active**|
|97140||Manual therapy, ea 15 minutes. NOTE: This is passive unless billed with an active procedure – in that case it would be considered active.||Passive|
|97150||Therapeutic procedure(s), group (2 or more individuals)||Active|
|97530||Therapeutic activities, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97532||Development of cognitive skills to improve attention, memory, problem solving, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97533||Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) pat contact, ea 15 minutes.||Active|
|97535||Self-care/home management training, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97537||Community/Work reintegration training, direct (one-on-one) pt contact, ea 15 minutes.||Active|
|97542||Wheelchair management ea 15 minutes||Active|
|97545||Work hardening/conditioning, initial 2 hours||Active|
|97546||Work hardening/conditioning, ea addl hour||Active|
|97799||97799 Unlisted physical medicine/rehabilitation service or procedure. **Passive or Active will depend upon the procedure.||Passive or Active**|
|98940||Chiropractic manipulative treatment, spinal 1-2 regions||Passive|
|98941||Chiropractic manipulative treatment, spinal 3-4 regions||Passive|
|98942||Chiropractic manipulative treatment, spinal 5 regions||Passive|
|98943||Extraspinal, 1 or more regions||Passive|