Physical therapy medical billing is a time-of-day, high-documentation practice that has significant and recurring revenue consequences from small procedural missteps in coding. Physical therapists provide patient care in a mix of timed and untimed procedures and modalities, respectively, and each type of procedure has distinct billing rules. When Physical Therapy Medical Billing combines these categories, money is lost on each encounter.
Timed Versus Untimed Codes in Physical Therapy Medical Billing
The first principle in physical therapy medical billing is that there are timed and untimed codes. Timed therapeutic procedure codes, such as therapeutic exercise, neuromuscular reeducation and manual therapy, are billed in units, reflecting the time the service was delivered. Untimed procedures, like electrical stimulation, hot and cold packs, and ultrasound, are billed as a single unit regardless of how long the treatment takes.
It’s a very common mistake to include the time of untimed procedures when calculating time for timed procedures. Only the time on the timed procedures counts towards the unit count. When the minutes for the untimed procedures are added to the total, the unit count increases, and there is a risk of over-coding—not counting the timed minutes that were documented leads to under-coding the units and decreasing reimbursement.
The 8-Minute Rule in Physical Therapy Medical Billing
Medicare’s 8-minute rule determines the number of units billed for physical therapy timed procedures. To bill a unit of a timed procedure, a minute of that procedure must be delivered for at least eight minutes, with extra units billed for the total timed service minutes for all timed procedures in the session. Many practices misapply this rule and underbill on a substantial number of their Medicare sessions.
The 8-minute rule mandates that the total timed service minutes for a session be calculated, and then the total be divided into units based on the Medicare conversion table. Physical therapy medical billing teams that use the units per procedure rather than the units per total minutes of the session are adding the wrong number of units. This is a systemic problem that extends to each visit.
KX Modifier and Therapy Cap Compliance in Physical Therapy Medical Billing
Medicare’s therapy cap requires the KX modifier for all therapy claims above the threshold for the calendar year. Physical therapy medical billing software needs to monitor the total amount of therapy billed for each beneficiary and add the KX modifier where necessary. If not, claims above the threshold will be denied and require a manual appeal for fully covered services.
Ophthalmology Medical Billing: Managing the Medical and Surgical Revenue Divide
Ophthalmology medical billing encompasses two different revenue streams with different coding rules. Evaluation and management eye examination codes are used to bill medical eye care services such as diagnosis and treatment of glaucoma, macular degeneration and diabetic retinopathy. Surgery, including cataract surgery and injections into the eye, is billed using procedure-based codes with global periods. Ophthalmology Medical Billing deals with both.
Eye Examination Codes in Ophthalmology Medical Billing
Ophthalmology medical billing involves two different sets of examination codes. Ophthalmological service codes are used for ophthalmologists’ patient eye exams for new and established patients. Evaluation and management (E&M) codes apply when the visit is focused on a medical diagnosis, rather than an examination of the eye. Inappropriate use of the code set for the encounter type results in a denial, which must be resolved by reviewing the documentation.
What dictates the use of ophthalmological service codes or E&M codes for medical billing of ophthalmology office visits is the documentation of the purpose and content of the visit. Medically necessary visual acuity and refraction justify an ophthalmological service code. A visit for the treatment of diabetic macular edema usually supports an E&M code. Combinations of these without justification in the documentation are not uncommon.
Surgical Coding and Global Periods in Ophthalmology Medical Billing
Cataract surgical procedures are one of the most common surgical encounters in ophthalmology medical billing, and one of the most commonly miscoded. Whether a cataract surgery is a routine or complex cataract removal with pupil expansion or iris manipulation makes a difference in the CPT code and reimbursement. Ophthalmology medical billing that uses the default simple code regardless of the complexity of the surgical procedure undervalues the surgical visit.
The global period is also vital to ophthalmology medical billing. Major ophthalmic surgery has a 90-day global period, making all post-operative visits part of the surgical fee and prohibiting additional billing without documentation and coding of a new problem or an unrelated service with an appropriate modifier. Perhaps the most frequent error in ophthalmology medical billing is to bill post-operative visits as routine office visits during a global period.
Billing Precision That Serves Every Clinical Encounter
The intricacies of physical therapy medical billing and ophthalmology medical billing are different, with differing financial outcomes. Med Brigade ensures that certified experts in both fields correctly bill these two specialties to ensure that every minute, every examination section and every surgical procedure is billed and collected.
