Knowing the billing codes required for occupational therapy is representative of the successful running of an occupational therapy practice. Being well-informed about the occupational therapy billing code can make a big difference in your revenue-be it that you are a seasoned expert of many years or a fresh graduate-and most importantly, in patient care. In this blog, we are going to cover everything you need to know about occupational therapy billing codes: what they are, why they are important, and even give a few tips

What are Occupational Therapy billing codes?

Occupational therapy billing codes are special codes used for the identification of services provided to the patients. These codes will enable insurers to find out how much to pay the therapists for their services. Each procedure, assessment, or treatment will have its unique code, and accuracy in these codes is very vital for payments to go through with time.

If you are giving therapy to a stroke victim, you have to code what particular services you rendered. Inappropriate coding may lead to denials of claims, delays of payment, and even litigations against the best of your interest.

Why are they important?

Reimbursement Proper coding directly impacts your practice income. Proper coding of the services performed assures that you are paid timely and efficiently.

Codes are very clear records of the services provided, which is quite helpful for both legal and clinical purposes.

Data Tracking: It helps practices analyze the delivery of services, track the outcomes, and further assess the effectiveness of treatments with coding.

Common Occupational Therapy Billing Codes

There are several codes to learn, and some of the basic common occupational therapy billing codes can be found below.

Evaluation Codes 97003, 97004 These codes are for initial consultations. If you are performing an evaluation on a new patient, you would charge one of these codes for your time.

CPT code 97110 and 97112: Therapeutic Procedures. These codes are to be used when the physician performs either therapeutic exercises or neuromuscular reeducation.

Group Therapy Code 97150: You will apply this code in cases where you are conducting a group of therapy.

Functional Capacity Evaluation (97530): This will be applied when determining the extent to which a patient is capable of performing activities related to work or accomplishing tasks involving daily living.

Training in self-care- code 97535: This will apply if you are treating a patient who has become more independent in completing his activities of daily living such as dressing or bathing.

Smarandache Notations-Useful Hints for Correct Encoding

Keep Current: Codes are updated annually. It’s important to stay current on changes coming out from the American Occupational Therapy Association and Centers for Medicare & Medicaid Services.

Be Specific: Always select the code that provides the most detail. For example, other than a code for “therapeutic exercises,” a coder should choose a code that describes the type or nature of the exercise.

Document your codes: This means describing not only the condition of the patient and the treatment you provided, but also the results observed.

Practical Experience: A Billing Problem Let me illustrate this with a story told quickly. Some months ago, I was working with a new occupational therapist who was having some problems with her billing. She had used some generalized code without specifying the treatment covered. We sat down and went over her coding, and soon we were able to find where all these problems were occurring. In fact, it wasn’t until they started getting into those more specific codes and provided matching documentation for the services performed that they began to receive timely payments. It was something of a revelation to them and for their practice!

Common Mistakes to Avoid

Using old codes: Make sure the most updated codes are applied. The use of old codes is typically the cause of denial for claims.

Incomplete/incorrect documentation: This is probably where most denials occur when the actual documentation does not support the code used.

Not following the different payers’ guidelines in their requirements of billing. Different insurers may have various guidelines used for their billing. It is essential to learn these in order not to have problems. X Overlooking Modifiers: Sometimes you are going to want to add modifiers to your codes. These are additional indicators that will explain in more detail what service you are providing for.

How to Make Sure Your Billing Succeeds

Invest in training. Keep up with the latest and greatest billing practices, and also with your staff. Consider regular training sessions to cover items such as new software.

Technology Use: Use billing software to help organize your codes, track your claims, and walk you step by step through the billing process. These programs can eliminate a lot human error.

Billing checklist: This may be necessary in order to ensure that necessary information is on hand prior to the actual submission of a claim. Items to include here should contain information on the patient, code of procedure, and supporting papers or records.

Payer Policy Understanding

Each one has its own rules and guidelines as to how to bill, and you will have to familiarize yourself with each of their policies. Some may require pre-authorizations for covered services, while others want session limits. Knowing these guidelines can help you avoid surprises that might equate to denials or decreased reimbursements.

Building a Relationship with Payers

If there is one particular payer that keeps giving you similar problems, then call them and ask them to explain to you or to help you. Many times they will be of great value in providing information that may affect exactly how you file your claims.

The Role of Patient Education

Educate your patient about billing, also. This will give them confidence and take the mystery out of a lot of things. Engaging with the Community Join occupational therapist groups and forums to discuss issues on billing. This is quite rewarding, sharing your experiences with other people and gleaning from them. Many therapists have similar problems; it’s great to find out how they resolve them.

Conclusion

Successful use of occupational therapy billing codes begins with understanding. Be informed, avoid common mistakes, and invest in good relations with payers to negotiate better and wiser in the world of billing. This is not all about the money; it’s for your patient and the care he or she needs. ATT is important to proper billing that will support service delivery to serve your patients with great occupational therapy. Please share your experience in the box below, and let us learn from each other through an ongoing process of growth for our practice.