Billing codes communicate what care was provided and why.
- ICD-10 Codes: Describe a specific diagnosis, injury, or health condition. These codes are alphanumerical and follow a building block pattern. Characters 1-3 describe the general type of injury and characters 4-7 describe specificity (e.g. M54.51, Vertebrogenetic Low Back Pain)
- CPT Codes: Is a five digit number that describes exactly what the healthcare provider did during the treatment (e.g., Therapeutic Exercise). These can fall into “timed and untime” codes.
In rehab therapy, accurate coding ensures claims reflect medical necessity and service complexity. Incorrect codes result in denials or underpayments. Integrated documentation workflows and coding optimization help reduce coding errors by flagging incompatible code combinations (CCI edits) before submission.
Why it matters:
Accurate coding protects revenue and reduces denials. It ensures you are paid for the work you performed.
Pro Tip:
Stop memorizing rulebooks. Automation supports documentation and optimized coding. Intelligent software should handle the modifier rules so you can focus on the patient.
FAQ
- Who assigns billing codes? Typically the treating clinician selects the codes based on the intervention, though billing teams may review them.
- What is the 8-minute rule? A Medicare rule that determines how many units of time-based CPT codes you can bill based on the total treatment time. This rule allows therapists to bill for a full 15 minute unit as long as they have provided at least at least 8 minutes of that specific treatment.
- What is a modifier? A two-digit code added to a CPT code to provide extra context, such as indicating a service was distinct or required by a specific therapy cap exception.
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