Common Physical Therapy ICD-10 Codes

Physical therapy ICD 10 codes are used by physical therapists in the United States for billable services. While any practicing therapist will be familiar with the process of searching for and choosing these codes, many of them have never learned about the structure and purpose of these codes and how to select a code that maximizes the likelihood of insurance covering their services. If you are ready for a primer in physical therapy ICD 10 codes, keep reading to learn more about physical therapy ICD 10 codes and common coding mistakes to avoid.

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What are physical therapy ICD 10 codes?

The International Classification of Disease, 10th Revision (ICD 10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice. In 2015, physical therapists and all other HIPAA-covered healthcare providers transitioned from the ICD-9 to the current version, ICD 10. Physical therapy ICD 10 contains two code sets: ICD 10 CM and ICD 10 PCS. The PCS code set is used only for inpatient procedures and will not be discussed further in this article. The CM code set, short for Clinical Modification, is used in outpatient and clinical settings in the U.S and will be discussed further here.

The purpose of ICD codes, according to the Centers for Medicare and Medicaid Services, is to promote international comparability in the collection, processing, classification and presentation of mortality statistics. They identify a medical diagnosis and help insurance companies understand why the care you are providing is medically necessary and therefore, reimbursable. If you are a HIPAA-covered entity, you must submit these physical therapy ICD 10 codes if you are seeking reimbursement from an insurance company. You can select multiple codes that describe the primary condition and symptoms related to the condition but one code will be reported as a primary code.

All physical therapy ICD 10 codes are alphanumeric. They begin with a letter and are always between three to seven characters with a decimal point placed after the third character. The more characters it has, the more specific it is.

Each code follows the following structure:

• Characters 1-3 indicate the category of the diagnosis

• Characters 4-6 indicate etiology, anatomic site, severity or other clinical detail

• Character 7 is an extension value.or example:
  • A: Initial encounter (anything related to care of the initial injury)
  • D: Subsequent encounter (anything related to the phase of routine care of the injury while the patient recovers–this usually refers to rehabilitation)
  • S: Sequela (other conditions that may result from the presence of the primary condition)

Note, for fracture care, there are several more extensions (example: P, G, K, which signify malunion, delayed healing, or nonunion for a subsequent encounter)

Common physical therapy diagnostic codes

Bone fracture physical therapy diagnostic codes

When selecting physical therapy ICD codes, the code with the highest number of applicable characters should be chosen, at least on the first visit. Greater specificity with your physical therapy ICD 10 code is more likely to lead to reimbursement but it should always be supported by the patient’s medical record and clinical knowledge of the patient’s condition.

Common physical therapy ICD coding mistakes to avoid (mistakes that could cost you)

In today’s world of electronic health records, finding a physical therapy ICD 10 code is often as simple as typing words in a search box. You will be immediately presented with a list of codes related to the condition for which you are searching. Charting software makes it easy to find relevant physical therapy ICD 10 codes. What is not as easy, is understanding which code to select because the most obvious code is not necessarily the one that will best guarantee reimbursement by an insurance company.

While common physical therapy ICD 10 coding mistakes will increase the likelihood of claims being denied even when your treatments are medically necessary and should be covered by the patient’s insurance plan. Let’s take a look at some of these coding errors.

Non-billable, Nonspecific physical therapy ICD 10 codes

Since specificity is king in physical therapy ICD 10 codes, many of the most obvious and simplest codes are not specific enough to be billable as a primary code from an insurance perspective. You can find a list of over 20,000 codes on the free ICD10 Data website that are considered nonspecific, of which you want to be aware. Whenever you look up a code on this site, a green or red arrow (as well as a description) will indicate if it is specific enough to be billable as a primary code or not.

In these cases, the nonspecific code will have codes beneath it that contain a greater level of detail and you should look for one of these instead.

“Unspecified”, “not-otherwise-specified”, “not elsewhere classified”

Example:

• M25: Other joint disorder, not elsewhere classified

• M71.5 Other bursitis, not elsewhere classified

These physical therapy ICD 10 codes can be found for a whole host of medical conditions. The clue to these codes is they will include the words “unspecified”, “not-otherwise-specified”, “not elsewhere classified”. In some cases this code may be applicable to the case you are treating, but not be used as the primary diagnosis code if there are more specific codes that can be used instead. There are some codes like “Unspecified abnormalities of gait and mobility” that are considered specific enough but you can reference the ICD10 Data Website to double check.

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Multiple site diagnoses

Example: M10.09 Idiopathic gout, multiple sites

In some cases you may be addressing symptoms or conditions related to multiple sites in the body. For example, when treating a patient with gout in more than one joint or osteoarthritis in several joints. In this case it might seem appropriate to choose the code M19: osteoarthritis, to indicate that it exists in more than one place. This, however, is considered a nonspecific code and should not be used for reimbursement purposes.

Instead, when possible use the physical therapy ICD 10 code that includes “multiple sites”. For example, M43.19: Spondylolisthesis, multiple sites in spine. If a “multiple sites” option is not available for that diagnosis, you should include a physical therapy ICD 10 code for each body site involved.

External cause of place of occurrence codes

• The code Y92 denotes “place of occurrence”
• Example:
  • Y92.328: Other athletic field as the place of occurrence of the external cause

External cause codes range from V00-Y99

• Examples:
  • W61.62: Struck by duck
  • W50.0: Accidental hit or strike by another person

These physical therapy ICD 10 codes can be used during the initial evaluation to increase specificity of the primary diagnosis. For instance, if you are treating a soccer player who sprained his MCL on the field and came straight to you through direct access, you could use S83.411A (Sprain of medial collateral ligament of knee, initial encounter) as the primary code and then list W50.0XXA as the external cause (initial encounter) and Y92.328 as the place of occurrence. Typically the external cause and place of occurrence codes would not be reported again during follow up visits.

Now that we have reviewed the purpose and structure of physical therapy ICD 10 codes and what to avoid, take a look at some common examples for the shoulder and low back and how we can apply these concepts to a couple of real-life coding examples.

Low back pain with sciatic nerve pain resulting from a car accident 2 weeks ago

Codes reported at initial evaluation

Codes that could be reported at subsequent follow up

• M54.41: Lumbago with sciatica, right side

• R26.89: Other abnormalities of gait and mobility

• R53.1: Weakness of right leg

Physical therapy post-left shoulder rotator cuff repair

Time: 3 weeks ago

In this case the original injury, the rotator cuff repair, is healed by the surgery and you are now providing post-surgical aftercare.

Use the Z Code for post-surgical aftercare in combination with codes that describe current symptoms:

• Z47.89: Encounter for other orthopedic aftercare

• M25.512: Pain in left shoulder

• M62.522: Muscle wasting and atrophy, not elsewhere classified, left upper arm

Understanding and knowing the best physical therapy ICD 10 code is paramount to getting paid for the services you provide. While there are tools to help you look up the best codes, having them at your fingertips in an EHR can save you precious time.

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How EHR and practice management software can save you time with insurance billing for therapists

EHR with integrated billing software and a clearing house, such as TheraPlatform offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to creating, sending and tracking medical claims through features such as automation and batching.

What are automation and batching?

• Automation refers to setting up software to perform a series of tasks with limited human interaction.

• Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

• Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.

• Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing and the billing software will automatically charge the card (easier than swiping!)

• Email payment reminders: Never manually send another reminder email for payment again or skip this all together by enabling auto credit card charge.

• Automated claim creation and submission: Batch multiple claims with one click of a button or turn auto claim creation and submission on.

• Live claim validation: The system goes over each claim to catch any human errors before submitting, saving you time and reducing rejected claims.

• Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA all the payments from them will be automatically posted on TheraPlatform’s EHR.

• Tracking: Track payment and profits including aging invoices, overdue invoices, transactions, billed services, service providers.

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Utilizing billing software integrated with an EHR and practice management software can make the storage and sharing of billing and insurance an easy decision and can save providers time when it comes to insurance billing for therapists.

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