Coding and Payment Guide

for the Physical Therapist

An essential coding, billing, and payment
resource for the Physical Therapist

American Physical Therapy Association

Introduction

Coding systems and claim forms are the realities o f modem. Health care providers need to be awareof the necessity for
health care. Of the multiple systems and forms available, specific diagnosis coding. Using only the first three digits of
what you use is greatly determined by the setting, the type the ICD-9.CM diagnosis code when fourth and fifth digits
of insurance, and your practice style. are available will result in a delay in payment and requests
for additional information from the provider.
This book provides a comprehensive look at the coding and
reimbursement systems used by physical therapists. It is HCPCS Level I (CPT) Codes
organized topically and numerically, and can be used as a The Centers for Medicare and Medicaid Services (CMS), in
comprehensive coding and reimbursement resource and as. conjunction with the American Medical Association (AMA),
aquick lookup resource for coding.
the American Dental Association (ADA) and several other
professional groups have developed, adopted, and
Coding Systems implemented athree-level coding system describing services
?Thecoding systems discussed in this coding and payment rendered to patients. Level | and the most commonly used
guide seek to answer two questions: What was wrong with system is the CPT coding system published annually and
the patient (Le, the diagnosis or diagnoses) and what was copyrighted by the AMA. This system reports outpatient and
done to treat the patient {i.e., the procedures o r services provider services.
rendered).
CPT codes predominantly describe medical services and
Coding systems grew out of the need for data collection. By procedures, and have been adapted to provide a common
having a standard notation for the procedures performed billing language that providers and payers can use for
and for the diseases, injuries, and illnesses diagnosed, payment purposes. The codes are becoming more widely
statisticians could identify effective treatments as well as used and required for billing by both private and public
broad practice patterns. Before long, these early coding insurance carriers, managed care companies, and workers?
systems emerged as the basis to pay claims. compensation programs.
Under the aegis oft h e federal government, a three-tiered ?TheAMA's CPT Editorial Panel reviews the coding system
coding system has emerged for physician offices and annually and adds, revises, and deletes codes and their
outpatient facilities. Physicians? Current Procedural descriptions. These changes are published annually and
Terminology (CPT*) codes report procedures and physician available for use January | of each year. The panel accepts
services comprises Level I. A second level, known as HCPCS
information and feedback from providers about new codes
Level II codes, largely report supplies, non-physician and revisions to existing codes that could better reflect the
services, and pharmaceuticals. A third level of codes provided service or procedure. The American Physical
previously used ona local or regional basis is no longer in ?Therapy Association (APTA) is represented on the Ilealth
use. Dovetailing with each of the levels is the International
Care Professional Advisory Committee {HCPAC) for both
Classification of Diseases, Ninth Revision, Clinical Modification the AMA CPT Editorial Panel and the AMA Relative Value
{ICD-9-CM) classification system that reports the diagnosis Update Committee (RUC). The CPT HCPAC representative
of illnesses, diseases, and injuries. (A portion of ICD-9-CM, provides input for the development and revision of CPT
Volume 3, also contains codes for inpatient procedures and codes, while the RUC HCPAC representative provides input
is used exclusively by inpatient facilities.) Further into the establishment of relative values for the codes.
explanations of these coding systems will follow.
HCPCS Level II Codes
ICD-S-CM Codes HCPCS Level Il codes are commonly referred to as national
ICD-9-CM is used to classify illnesses, injuries, and patient codes or by the acronym IICPCS {Health Care Common
encounters with health care practitioners for services. Procedure Coding System ? pronounced ?hik piks").
?The ICD-9-CM classification system is a method of HCPCS codes are used for billing Medicare and Medicaid
translating medical terminology into codes. Codes within patients and have also been adopted by some third-party
the system are either numeric or alphanumeric and are Payers.
composed of three, four, or five characters. A decimal point HCPCS Level I codes, updated and published annually by
follows all three-character codes when fourth and fifth CMS, are intended to supplement the CPT coding system
characters are needed. ?Coding? involves using a numeric by including codes for non-physician services, durable
or alphanumeric code to describe a disease or injury. For medical equipment (DME), and supplies, These Level II
example, frozen shoulder is classified to code 726.0. codes consist of one alphabetic character (A through V)
Generally, the reason the patient seeks treatment should be followed by four numbers. In many instances, HCPCS Level
sequenced first when multiple diagnoses are listed. Claims Il codes are developed as a precursor to CPT.
forms require that the appropriate ICD-9-CM code be
reported rather than a description of the functional deficits.

a registered trademark of the American Medical Association.

CPT Is
©2003 ingenix, inc.
The Reimbursement Process

Receiving appropriate reimbursement for professional services © Services that are n o t p r o v e n to be safe and effective
can sometimes be difficult because of the myriad of rules and based on peer review o r scientific literature
paperwork involved. The following reimbursement guidelines * Experimental or investigational services
will help you understand the various requirements for getting
claims paid promptly and correctly.
© Services that are f u r n i s h e d at a d u r a t i o n , intensity, or
frequency that is n o t m e d i c a l l y appropriate

Coverage Issues © Services that are not furnished in accordance with

First, you need to know what services are covered. Covered accepted standards of medical practice
services are services payable by the insurer in accordance © Services that are not furnished in a setting appropriate to
with the terms o f the benefit-plan contract. Such services the patient's medical needs and condition
must be documented and medically necessary for payment
to be made. Typically, third-party payers define medically Payer Types
necessary services or supplies as: Most providers have to deal with a number of different
© Services that have been established as safe and effective payers and plans, each with its own specific policies and
methods of reimbursement. For that reason, it is important
¢ Services that are consistent with the symptoms or
to become familiar with the guidelines for every payer and
diagnosis plan that your practice has contact with. Some insurance
© Services that are necessary and consistent with generally plans are administered by either federal or state
accepted medical standards government, including Medicare, Medicaid, and TRICARE.
© Services that are f u r n i s h e d at t h e m o s t appropriate, safe, Private payers range from fee-for-services plans to health
a n d effective level maintenance organizations.

D o c u m e n t a t i o n m u s t be p r o v i d e d t o s u p p o r t the m e d i c a l Medicare
necessity o f a service, procedure, a n d / o r o t h e r items. This Administered by the federal government, Medicare provides
d o c u m e n t a t i o n s h o u l d show: health insurance benefits to those 65 years of age and older,
and individuals of any age who are entitled to disability
© What service or procedure was rendered
benefits under Social Security or Railroad Retirement
© To what extent the service or procedure was rendered programs. In addition, individuals with end-stage renal
©
Why the service, procedure, or other item(s} was disease that require hemodialysis or kidney transplants are
medically warranted also eligible for Medicare benefits. Consisting of two parts,
Medicare Part A {for which all persons over 65 are
When providing physical therapy services, it is especially
qualified) covers hospitalization and related care while Part
important for providers to thoroughly and individually B (which is optional) covers physician and other related
document all care given to each patient at each visit, health services. Fees for Medicare services delivered in the
including the amounto f time spent performing each
outpatient setting are based on the Medicare fee schedule.
intervention. When in doubt, providers should consult with
the payer or refer to local medical review policies for guidance. In addition, the Medicare+Choice plan, created in 1997 as
part ofthe Balanced Budget Act (BBA), allows managed care
Verify that all services billed are medically necessary. Ift h e plans, such as health maintenance organizations { HMOs)
provider feels that it is medically necessary for the patient and preferred provider organizations (PPOs), to join the
to receive physical therapy treatments that are more or less Medicare system. Access to these various options depend on
than the current standardo f practice, clearly document the where the beneficiary lives and the availability of plans in
rationale used for this decision in the patient's record. their community.
Physical and occupational therapy services are covered only
for restorative therapy, when there is the expectation of Medicaid
restoring a patient's level o f function that has been lost due Medicaid is administered by the state governments under
to injury or illness, and not to maintain a level of function. federal guidelines to provide health insurance for low-
Maintenance care is not be reimbursed by CMS. Other income or otherwise needy individuals. In addition to the
third-party payer policy may vary. broad guidelines established by the federal government,
Services, procedures, a n d / o r other items that m a y n o t be each state has the responsibility to administer its own
considered m e d i c a l l y necessary are: program including:

© Services that are not typically accepted as safe and

© Establishing eligibility standards
effective i n the setting where they are provided © D e t e r m i n i n g t h e type, a m o u n t , d u r a t i o n , a n d scope o f
services
© Services that are n o t g e n e r a l l y accepted as safe a n d
effective f o r t h e c o n d i t i o n b e i n g treated

©2003 ingentx, inc.

Coding a n d Payment Guide for the Physical Therapist

© Setting p a y m e n t rates f o r services Indemnity Plans

« Program a d m i n i s t r a t i o n Under indemnity plans, which are generally fee-for-service,
the payer provides payment directly to the provider of
TRICARE service when benefits have been assigned by the patient. Many
F o r m e r l y called C H A M P U S , TRICARE provides h e a l t h carriers now include PPO attributes to help reduce costs.
insurance to active a n d retired m i l i t a r y personnel a n d
dependents. Third-Party A d m i n i s t r a t o r s (TPAs) and
A d m i n i s t r a t i v e S e r v i c e s Organizations (ASOs}
B l u e C r o s s and B l u e Shield Although neither insurers or health plans, TPAs and ASOs
Blue Cross {hospital services) and Blue Shield (physician manage and pay claims for clients such as self-insured
services) were the first pre-paid health plan in the country. groups. The self-insured group then assumes the risk of
Although all ?Blues? plans are independent, they are united providing the services and may contract directly with
by membership in the national Blue Cross and Blue Shield providers or use the services o fa PPO.
Association (BCBSA). The Blue Cross and Blue Shield
System is responsible for the administrationo f the four Physician Hospital Organization (PHO)
million-member Federal Employee Program {FEP), Hospitals and physician organizations may create a PHO to
comprising all federal government employees, retirees, and assist in managed care contracting on behalf of the parties.
dependents. Degrees of management, common ownership, and
oversight vary depending on the model of the arrangement.
Health Maintenance Organizations (HMOs)
The most common form o f managed care is the LIMO. This Payment Methodologies
type of plan has several variations, but basically, the Once covered services are known, the next issue to resolve
subscriber pays a monthly fee for services, regardless of the is how you will be paid for those services. Over the last
type or amounto f services provided. The primary care several years, there have been major changes to provider
physician (PCP) acts as a gatekeeper to coordinate the payment systems. The following will discuss the many
individual's care and to make decisions regarding specialty varieties of payment methodologies used by Medicare and
referral and care. In a ?group model? HMO, referrals for other third-party payers for outpatient and inpatient claims.
care outside oft h e large independent physician group must
be arranged, care for emergency services must be Diagnosis-related Groups (DRGs)
preauthorized, and information about care provided i n a DRGs apply to inpatient acute hospital/facility settings
life-threatening situation must be communicated to the only, grouping multiple diagnoses together. Reimbursement
plan within a specified periodo f t i m e . On the other hand, is based on this grouping rather than on the actual services.
the managed choice model HMO allows individuals to Inpatient stays typically use revenue codes to describe the
access care via the PCP or to go outside of the network to treatments or procedures rendered.
receive care without permissiono f the PCP, but at a lower
level of benefits. A m b u l a t o r y P a y m e n t Classifications (APCs)
APCs, Medicare's new outpatient prospective payment
Preferred Provider Organizations system, is a methodology for payments to hospitals for a
Preferred provider organizations {PPOs), are generally wide rangeo f f a c i l i t y services when performed on an
contracted by an employer group or other plans to provide outpatient or a partial hospitalization basis. It differs from
hospital and physician services at reduced rates. Although the Diagnosis-related Grougs (DRGs) used by hospitals in
coverage is higher for preferred or participating providers, that DRGs are driven by ICD-9-CM diagnostic groups,
individuals have the option to seek services provided by where APCs are grouped by the actual service provided.
non-participating providers. A variation of the PPO is the CPT and HCPCS codes are organized into payment groups,
exclusive provider organization (EPO,) where enrollees with a fixed payment for each group that is geographically
must receive care within the network and must assume adjusted.
responsibility for all out-of-network costs.
Some services have been exempted from APC payment
Point-of-Service Plans (POS) methodology and will continue to be paid in accordance
Point-of-service plans permit covered individuals to receive with the respective fee schedules for these specific services.
services from participating or nonparticipating providers, These services include: end-stage renal disease services;
but with a higher level of benefits when participating laboratory; durable medical equipment; screening
providers are used. mammography; ambulance services; pulmonary
rehabilitation; and clinical trials.
I n d e p e n d e n t Practice Association (IPA)
For more information on APCs, see our Ingenix
This type of organization comprises physicians that
Publications identified in the frontof this publication.
maintain separate practices and participate in the IPA as a
means to contract with HMOs or other health plans. The Usual, Customary, and Reasonable
physicians also generally treat patients who are not Fee-for-service r e i m b u r s e m e n t based o n reasonable a n d
members of the HMO or other plans. c u s t o m a r y charges was the m e t h o d that Medicare, as w e l l as

©2003 Ingentx, inc.

Documentation ? An Overview

The role played by medical documentation has always been without prior notification from the physician. Medical
a supportive one. As the practice of medicine became more necessity requires items and services to be:
sophisticated and complex, the need to record specific
* Consistent with symptoms or diagnosis of disease or
clinical data grew in importance. What certainly began as a
injury
simple written mechanism to jog the memory of a treating
physician evolved into a more refined system to service Necessary and consistent with generally accepted
others assisting in patient care. Tracking patient history professional medical standards (e.g., not experimental
emerged as a fundamental element in planning a course of or investigational)
treatment. When medical specialties evolved early in the « Furnished at the most appropriate level that can be
last century, the patient record offered a means to provide provided safely and effectively to the patient
pertinent data for referrals and consultations.
Computer conversion of the review process in the 1980s
Still, until about 35 years ago, no clear standards existed for added a new twist: speed and a degree of accuracy. Claims
recording patient information. Medical documentation was adjudication, data analysis, and physician profiling revealed
seen, maintained, and used almost exclusively by incongruities. A significant number of physicians and
physicians and medical staff. Patient care information was hospitals were found to have billed for services that were
never submitted to insurance companies or to government not provided or found to be medically unnecessary.
payers; only rarely did medical documentation become the Projected total estimates in the millions of dollars were
focus of malpractice suits. publicized by CMS as findings of fraud and abuse. These
Developments in the mid-1970s, however, irrevocably findings led to the creationof t h e federal fraud and abuse
affected the role o f documentation i n medicine. A dramatic program coordinated by several federal organizations,
national increase in medical malpractice claims and awards including the Department of Health and Human Services
abruptly altered the strictly clinical nature of documentation. {HHS) and its agencies, CMS, and the Office of Inspector
?The patient medical record was swept into the broad realm General (OIG). In 1997, CMS reported a possible $23
of civil law. Since most medical liability suits approach billion in questionable Medicare payments due to
resolution years after the contested care, the medical record documentation problems in the hospital and outpatient
settings.
provides a main source of information about what
happened. The patient record became a legal document, a Commercial insurance companies were quick to follow suit.
basis to reconstruct the quality and quantity of health care Similar to CMS, private payers monitor claims to uncover
services. In many instances, it also serves as a provider's coding mistakes and to verify that the documentation
only defense against charges of malpractice. supports the claims submitted. Although there are no.
national guidelines for proper documentation, the
Marked changes to the Medicare program also served to
guidelines this chapter provides should ensure better
broaden the influence for medical documentation during
quality of care and increase the chances of full and fair
the 1970s, For example, the Centers of Medicare and
reimbursement.
Medicaid Services (CMS), Medicare's federal administrator,
authorizes the program's regional carriers to review paid
General Guidelines for Documentation
claims to determine whether the care was medically
necessary, as mandated under the Social SecurityAct of 1996. Documentation is the recording o f pertinent facts and
observations about a patient's health history, including past
This type of review checks processed and paid claims and present illnesses, tests, treatments, and outcomes. The
against the documentation recorded at the time o f service. medical record chronologically documents the care o f the
The aim is to ensure that Medicare dollars are administered patient to:
correctly and, once again, medical documentation must
¢ Enable a health care professional to plan and evaluate
support the medical necessity o f the service, to what extent
the service was rendered, and why it was medically the patient's treatment
justified. For example, a physical therapist re-evaluates a ¢ Enhance communication and promote continuity of
patient after the prescribed treatment plan has been care among health care professionals involved in the
completed. The physical therapist determines that the patient's care
patient would continue to benefit from further encounters « F a c i l i t a t e claims review a n d p a y m e n t
for manual traction and therapeutic exercise. Depending
« A s s i s t i n u t i l i z a t i o n review a n d q u a l i t y o f care
upon the payer guidelines, this may require prior
evaluations
authorization from the primary care physician, or the payer.
* Reduce hassles related to medical review
Medicare does not pay for services that are ?medically
unnecessary,? according to Medicare standards, Patients are * Provide clinical data for research and education
not liable to pay for such servicesi f the service is performed

©2003 ingentx, inc.

Coding a n d P a y m e n t Guide for the Physical Therapist

© Serve as a legal document to verify the care provided « The patient's progress, including response to treatment,
(eg. as defense f professional liability
in the case o a change in treatment, change in diagnosis, and patient
claim) noncompliance, should be documented.
Payers w a n t t o k n o w that their health care dollars are w e l l © The written plan for care should include treatments and
spent. Because they have a c o n t r a c t u a l o b l i g a t i o n t o medications?specifying frequency and dosage, any
beneficiaries, they l o o k for the d o c u m e n t a t i o n to validate referrals and consultations, patient and family
that services are: education, and specific instructions for follow-up.
« Appropriate for treating the patient's condition
¢ The documentation should support the intensity of the
patient evaluation and the treatment, including thought
¢ Medically necessary for the diagnosis processes and the complexity of medical decision
* Coded correctly making.
« A l l entries to t h e medical record s h o u l d be dated a n d
Coding Tip authenticated.
Documentation guidelines developed specifically for © T h e codes reported o n t h e health insurance c l a i m f o r m
the physical therapist by the American Physical o r b i l l i n g statement s h o u l d reflect t h e d o c u m e n t a t i o n
Therapy Association will be discussed in detail i n t h e medical record.
further in this chapter.
To ensure the appropriate reimbursement for D o c u m e n t a t i o n t o C o d e a n d Bill
services, the provider should use documentation to Many insurers rely on written evidence of the evaluation of
demonstrate compliance with any third-party payer the patient, care plan, and goals for improvement to
utilization guidelines. determine and approve the medical necessity o f care. Initial
evaluation findings documenting the diagnosis form the
Principles of Documentation basis for judging the reasonableness and necessityo f care
To provide a basis for maintaining adequate medical record that was subsequently provided. Consequently, the more
information, follow the principles o f medical record accurately the patient's evaluation and treatment are
documentation listed. The principles below have been described, the easier it is to code the diagnoses and
developed by representatives o f the following procedures properly.
organizations:
(CD-9-CM Coding
© American Health Information Management Association ICD-9-CM codes relate to the medical diagnosis and are
(AHIMA) used to classify illnesses, injuries, and reasons for patient
© American Hospital Association (AHA) encounters with the health care system. Patients may have a

© American Managed Care and Review Association single primary, or one primary and several secondary
diagnoses. Medical diagnoses are sequenced by order of
(AMCRA)
severity or importance.
American Medical Association (AMA)
Describing the onset of the problem and objectively
© American Medical Peer Review Association (AMPRA)
documenting the patient's impairment are essential to
© Blue Cross and Blue Shield Association ensuring accurate coding and description of the diagnosis.
* Health Insurance Association of America (HIAA) Confirming any diagnosis is based on objective
measurements performed and values obtained during an
Medical Record Documentation assessment. The diagnostic description of the current
« The medical record s h o u l d be c o m p l e t e a n d legible. problem for which the patient is being treated should be
defined by:
« The documentation of each patient encounter should
include the date, the reason for the encounter, Patient's subjective complaint
appropriate history and physical exam {when ¢ Problem's date of onset
applicable), reviewo f lab and x-ray data, as well as
other ancillary services (where appropriate), an
© Objective test values confirming the diagnosis
assessment, and plan for care (including discharge plan, * Outcomes expected after treatment
if appropriate).
For more information tailored to your specialty, see the
© Past and present diagnoses should be accessible to the chapter on diagnostic coding.
treating or consulting health care professional.
« The reasons f o r a n d results o f x-rays, lab tests, a n d o t h e r Coding Tip
a n c i l l a r y services s h o u l d be d o c u m e n t e d and i n c l u d e d At each visit, the therapist should record the medical
i n t h e medical record. condition being treated.
* Relevant health r i s k factors s h o u l d be i d e n t i f i e d .

©2003 ingenkx, inc.

Claims Processing

The m o s t i m p o r t a n t d o c u m e n t for correct r e i m b u r s e m e n t is has agreed to have insurance p a y m e n t s sent directly to t h e

the insurance claim, w h e t h e r i t is s u b m i t t e d electronically physician a n d t h a t medical i n f o r m a t i o n can be released to
o r ona standardized paper c l a i m f o r m . O t h e r i n f o r m a t i o n , the patient's insurance company. A signed copy o f t h i s
such as operative reports, chart notes, a n d cover letters m a y assignment s u b m i t t e d w i t h a c l a i m helps ensure at least
establish medical necessity, b u t the c l a i m ?sets the stage.? p a r t i a l p a y m e n t f r o m m o s t c o m m e r c i a l insurers.
Assignments also reduce c o l l e c t i o n expenses. A n alternative,
The term ?claims processing? describes the course of
l i f e t i m e assignmento f benefits s h o u l d nearly e l i m i n a t e t h e
submitting a claim to the payer and subsequent need to o b t a i n a signature after each date o f service;
adjudication. Understanding how this process works allows however, there are payers that require a current signature
physicians and staff members to file claims properly and w i t h each c l a i m .
leads to maximum and timely reimbursement. In addition,
this knowledge will allow the provider's office to serve as a I f the office participates with Medicare, an assignment of
Tesource to patients i n understanding the process. benefits and releaseo f b i l l i n g are necessary.

With commercial insurance companies, submit the claim Determining Coverage

directly to the payer or provide the patient with the A patient's insurance coverage s h o u l d be verified before any
necessary information to submit the claim. If there is a service is rendered w i t h the c o m m o n sense exception o f
signed agreement with Blue Cross and Blue Shield or with emergency treatment. T h i s p o l i c y s h o u l d n o t a p p l y
an HMO or PPO, the office may be required to send the exclusively to n e w patients. Established patients m a y have
claim directly to the insurer. Medicare requires that the changed employers, married or divorced, or no longer be ey
office submit all Medicare claims directly to the carrier, covered by the same policy that was in effect during the last 3
whether participating or not i n the Medicare program. visit. The law requires Medicaid patients to provide current f
For paper claims, use standard claim forms {CMS-1500 and proof of eligibility with each visit. Z
the UB-92 described in this chapter) when submitting
Preauthorization
charges, and be sure to complete the forms completely and
Determining in advance the benefits and allowables
accurately.
provides the physician's office with reimbursement figures
before the patient's visit. Under most circumstances, the
W h a t t o I n c l u d e on C l a i m s
office should be able to discuss the deductible, copayment,
Patient I n f o r m a t i o n and balance over and above the allowable with the patient
Before filing any claim, obtain clear, accurate information prior to providing costly services. Asking a few pointed
from the patient, and update the information regularly. questions of the patient and insurer will provide additional
Most offices verify the information at each visit. A uniform information regarding deductibles, for example:
policy for multiple provider offices or clinics makes © How much is the deductible and has it been met for the
everyone accountable for current and correct patient data.
current year?
P r i m a r y vs. S e c o n d a r y C o v e r a g e * What are the allowables for the quoted procedures?
Households with dual incomes often have more than one © What percentageo f the allowables will be paid?
insurer, Determine which is the primary and which is the
secondary insurance company. For commercial plans, the Clean Claims
subscriber's or insured?s insurance company is always Claims submitted with all of the information necessary for
primary for the subscriber. In other words, the husband's processing are referred to as ?clean? and are usually paid in
insurance company is primary for him and the wife's a timely manner. Paying careful attention to what should
insurance company is primary for her. However, the appear on the claim form helps produce these clean claims.
primary insurance company for any dependents is Common errors include the following:
determined by the insureds? birthdays, the primary insured
being the individual whose birthday is first during the year. ¢ Failure to pay attention to communications from
This is often referred to as the ?birthday mule.? For example, carriers (including Medicare and Medicaid transmittals)
if the husband?s birthday is October 14, 1960 and the wife?s ¢ An incorrect patient identification number
birthday is March 1, 1962, the wife is primary for their © Patients? names and addresses that differ from the
dependents because her birthday is first during the year insurers? records
(year of birth is ignored).
© Physician tax identification numbers, provider numbers,
Assignment o f Benefits and Release o f or Social Security numbers that are incorrect or missing
Information
C o n s i d e r a d d i n g an a s s i g n m e n t o f benefits statement t o t h e
* No or insufficient information regarding primary or
secondary coverage
p a t i e n t i n f o r m a t i o n f o r m . It s h o u l d state that the p a t i e n t

©2003 ingenix, inc. 37

CPT Definitions and Guidelines

Physicians? Current Procedural Terminology, Fourth Edition, CPT Symbols

(CPT*) is developed, published, and copyrighted by the There are several symbols used i n the CPT book:
American Medical Association annually. CPT codes describe
« A b u l l e t {@) before t h e code m e a n s that t h e code is n e w
predominantly medical services and procedures performed
to the CPT c o d i n g system i n t h e current year.
by physicians and nonphysician professionals. The codes
are classified as Level | of the Healthcare Common A t r i a n g l e (a) before the code means that the code
Procedure Coding System (HCPCS). narrative has been revised in the current year.
¢ T h e s y m b o l s » 4 enclose n e w o r revised text o t h e r t h a n
In general, whenever possible, physical therapists should
consider using CPT codes to describe their services. One t h a t c o n t a i n e d i n t h e code descriptors.
reason is that government studies of patient care evaluate © Codes with a + symbol are ?add-on? codes. Procedures
utilization of services by reviewing these codes. Because described by ?add-on? codes are always performed in
payers may question or deny payment for a CPT code, addition to the primary procedure and should never be
direct communication is often useful in educating payers reported alone. This concept is applicable only to
about physical therapy services and practice standards. procedures or services performed by the same physician
Accurate coding also can help an insurer determine fo describe any additional intraservice work associated
coverage eligibility for services provided. with the primary procedure such as additional digits or
lesions.
Appropriate Codes for Physical © The symbol © designates a code that is exempt from the
Therapists use of modifier 51 when multiple procedures are
The CPT book is divided into six major sections by type of performed even though they have not been designated as
service provided (evaluation and management, anesthesia, "add-on" codes,
surgery, radiology, pathology and laboratory, and © Prior to 2004, the CPT book also contained a starred
medicine). These sections are subdivided primarily by body procedure designation (indicated by an asterisk after the
system. code) that signified a surgical procedure considered by the
American Medical Association {AMA) fo be a minor 8
The physical therapist in general practice will find the most 4
surgical procedure that did not indude pre- or
relevant codes in the physical medicine subsection of the 4
medicine section {codes in the 97001-97799 range). Other postoperative services. This designation, which was not 3
recognized for Medicare purposes, was eliminated in CPT Fi
services physical therapists provide, particularly those in
2004. Check with individual payers to determine their =
specialty areas, are described under their appropriate body a
specific billing guidelines.
system within the medicine or surgery section.

For example, the neurological procedures most often

performed by physical therapists including Mor rs
A system of ewo-digit modifiers has been developed to
electromyography (EMG), are located in the neurology
subsection ofthe medicine section, (95831-95999), while allow the provider to indicate that the service or procedure
has been altered by certain circumstances or to provide
burn care codes (16000-16030) are located in the surgery
section. Noneo f the codes for these procedures are listed in additional information about a procedure that was performed,
the physical medicine subsection although they accurately ora service or supply that was provided. Fee schedules have
describe services provided by a physical therapist. been developed based on these modifiers. Some third-party
payers, such as Medicare, require physical therapists to use
Although codes within the physical medicine series. modifiers in some circumstances, and others do not
{97001-97799) may not accurately describe all physical recognize the use of modifiers by physical therapists for
therapy procedures, they are most easily recognized by coding or billing. Communication with the payer group
third-party payers as services provided by physical ensures accurate coding. Addition of the modifier does not
therapists. In many instances, you may be able to code alter the basic description for the service, it merely qualifies
accurately using all sections of the manual and obtain the circumstances under which the service was provided.
reimbursement if you can provide a reasonable rationale Circumstances that modify a service include the following:
directly to the payer for the service you are providing and
* Procedures t h a t have b o t h a technical a n d professional
support it with consistent, accurate documentation.
c o m p o n e n t were performed
However, some payers may refuse to pay for services coded
outside the physical medicine sections of CPT, or they may © More than one provider or setting was involved in the
attempt to limit physical therapists? use of such codes. service

* Only part o f a service was performed

¢ Unusual events occurred

@T only ©2003 American Medical Association. All Rights Reserved. CPTIs a registered trademarkof the American MedicalAssocation
©2003 Ingenix, inc. Add-On Code & Modifier 51 Exempt @ New Codes & Ghanged Codes eo
 Coding a n d P a y m e n t Guide for the Physical Therapist

For one example, modifier 22 could be used to indicate session by the same provider, the primary procedure
that the patient required the participation of more than one or service may be reported as listed. The additional
PT during an intervention. For another example, modifier procedures) or service(s) may be identified by
59 could be used when billing for both 97022, Whirlpool, appending the modifier 51 to the additional
and 97601, Wound debridement, ¢o indicate that the two procedure or service code(s).
services were distinct from one another, or performed on 52 Reduced Services: Under certain circumstances a
different areas o f the body. service or procedure is partially reduced or
N o t e t h a t t h e CPT b o o k uses t h e t e r m " p h y s i c i a n " w h e n eliminated at the physician's discretion. Under these
d e s c r i b i n g h o w a m o d i f i e r is to be used. This does n o t l i m i t circumstances the service provided can be identified
t h e use o f t h e m o d i f i e r s to physicians; a n y p r a c t i t i o n e r m a y by its usual procedure number and the addition o f
use a m o d i f i e r as long as t h e service o r procedure t o be the modifier 52, signifying that the service is
m o d i f i e d can be p e r f o r m e d w i t h i n t h a t practitioner's scope reduced. This provides a means of reporting reduced
of work. services without disturbing the identification of the
basic service.
The list of modifiers used most often by physical therapists:
59 Distinct Procedural Service: Under certain
2 U n u s u a l P r o c e d u r a l Services: W h e n t h e services(s) circumstances, the physician may need to indicate
p r o v i d e d is greater than t h a t u s u a l l y r e q u i r e d f o r t h e that a procedure or service was distinct or
listed procedure, i t m a y b e i d e n t i f i e d b y a d d i n g independent from other services performed on the
m o d i f i e r 22 to the usual p r o c e d u r e number. A report same day. Modifier 59 is used to identify
may also be appropriate. procedures/services that are not normally reported
Significant, Separately Identifiable Evaluation and together, but are appropriate under the circumstances.
Management Service by the Same Physician on the This may represent a different session or patient
Same Day of the Procedure or Other Service: The encounter, different procedure or surgery, different site
physician may need to indicate that on the day a or organ system, separate incision/excision, separate
procedure or service identified by a CPT code was lesion or separate injury {or area of injury in extensive
performed, the patient's condition required a injuries) not ordinarily encountered or performed on
significant, separately identifiable E/M service above the same day by the same physician. Ilowever, when
and beyond the usual preoperative and postoperative another already established modifier is appropriate it
care associated with the procedure that was should be used rather than modifier 59. Only if no
performed. The £/M service may be prompted by the more descriptive modifier is available, and the use of
= symptom or condition for which the procedure modifier 59 best explains the circumstances, should
S and/or service was provided. As such, different modifier 59 be used.
a diagnoses are not required for reporting of the E/M
Ea
6 Repeat Procedure by Same Physician: The physician
services on the same date. This circumstance may be may need to indicate that a procedure or service was
is
reported by adding the modifier 25 to the repeated subsequent to the original procedure or
appropriate level of E/M service. Note: This modifier service. This circumstance may be reported by adding
is not used to report an E/M service that resulted in a the modifier 76 to the repeated procedure/service.
decision to perform surgery.
26 Professional Component: Certain procedures are a Coding Tip
combination of a physician component and a technical Physical therapists in skilled nursing facilities might use
component. When the physician component is modifier 76 for patients paid under Medicare Part B.
reported separately, the service may be identified by These patients may receive services in both the
adding the modifier 26 to the usual procedure number. morning and the afternoon of the same day, and
modifier 76 would indicate that the services were not
Coding Tip duplicative.
Identifies that the professional component is being
HCPCS Level II modifiers may also be appended to CPT
reported separately from the technical component for
codes for services. Refer to the HCPCS Level II Definitions
the diagnostic procedure performed. Payment is
and Guidelines for a listing of the HCPCS Level II modifiers.
based solely on the professional component relative
value of the procedure.
Unlisted Procedure Codes
32 Mandated Services: Services related to mandated Not all medical services or procedures are assigned CPT
consultation and/or related services (eg, PRO, third codes. The book does not contain codes for infrequently
party payer, governmental, legislative or regulatory used, new, or experimental procedures. Each code section
requirement) may be identified by adding the contains codes set aside specifically for reporting unlisted
modifier 32 to the basic procedure. procedures. Before choosing an unlisted procedure code,
51 Multiple Procedures: When multiple procedures, carefully review the CPT code list to ensure that a more
other than E/M services, are performed at the same specific code is not available. Also, check for HCPCS Level

CPT only ©2003 American Medical Association, All Rights Reserved.

70 ?MED: Medicare Reference ©2003 ingentx, Inc.
Coding a n d P a y m e n t Guide for the Physical Therapist

Evaluation Motion Analysis

?Occupational Therapy by Video and 3-D Kinemattes, 96000
Re-evaluation, 97004 Computer-based, 96000
Physical Therapy ?Muscle Testing
Re-evaluation, 97002
Manual, 95831-95834
Evoked Potential Muscle
Somatosensory Testing, 95925-95927
Visual, CNS. 95930 Biofeedback Training, 90911
Myofascial Release, 97140
Exercise Stress Tests, 93015-93018
Nerve Conduction
Exercise Test Motor Nerve, 95900
Ischemic Limb, 95875
Sensory Nerve, 95904
Exercise Therapy, 97110-97113 Neurology
Expired Gas
Analysis, 94680-94690 Diagnostic
Extremity Testing Electromyography
Ischemic Limb Exercise Test, 95875
Physical Therapy, 97750 Needle, 95861-95872
Finger Surface
Splint, 29130-29131 1c,
96002-96003
Strapping, 29280 Higher Cerebral Function
?Aphasia Test, 96105
Flow Volume Loop/Pulmonary, 94375 Cognitive Function Tests, 96115
Foot Developmental Tests, 96110
Splint, 29590 Motion Analysis
Strapping, 29540 by Video and 3-D Kinematics, 98000
Gait Training, 97116 Computer-based, 96000
Muscle Testing
H-Reflex Study, 95934 Manual, 95831-95834
Hand Nerve Conduction
Strapping, 29280 Motor Nerve, 95900
Sensory Nerve, 95904
Heart Neuromuscular Junction Tests, 95937
Cardiac Rehabilitation, 93797
Neurophysiological Testing
Resuscitation, 92950
Intraoperative, 95920
Hip Neuropsychological Testing, 96117
Strapping, 29520 Plantar Pressure Measurements
ic. 96001
Hot Pack Treatment, 97010 Range of Motion Test, 95851
Hubbard Tank Therapy, 97036 Reflex
with Exercises, 97036 H-Reflex, 95934
Reflex Test
Hydrotherapy (Hubbard Tank), 97036 Blink Reflex, 95933
with Exercises, 97036
Somatosensory Testing, 95925-95927
Infrared Light Treatment, 97026 Visual Evoked Potential, CNS, 95930
Inhalation Treatment, 94640 Neuromuscular Junction Tests, 95937
Inhalation Neuromuscular Reeducation, 97112
Pentamidine, 94642 Intraoperative, Per Hour, 95920
Iontophoresis, 97033 Neurophysiologic Testing
doint Intraaperative, Per Hour, 95920
Mobilization, 97140 Neuropsychological Testing, 96117
Kinetic Therapy, 97530 Neurostimulation
Knee Application, 64550
Strapping, 29530 Occupational Therapy
Evaluation. 97003
Leg
Lower Orthotics
Splint, 29515 Check-Out, 97703
Strapping, 29580 Training and Fitting, 97504
Unna Boot, 29580
Upper Oximetry (Noninvasive)
Blood 02 Saturation
Splint, 29505
Ear or Pulse, 94760-94761
Strapping, 29580
Unna Boot, 29580 Oxygen Saturation
Manipulation Ear Oximetry, 94760-94761
Chest Wall, 94667 Pulse Oximetry, 94760-94761
Dislocation and/or Fracture Paraffin Bath Therapy, 97018
Chest Wall, 94667
Peak Flow Rate, 94150
Physical Therapy. 97140
Pentamidine
Manometry Inhalation Treatment, 94640
Rectum
Anus, 90911 Performance Test,
Phystcal Therapy, 97750
Manual Therapy, 97140
Massage
Physical Medicine/Therapy/Occupational Therapy
?Therapy, 97124 Activities of Daily Living, 97535
Aquatic Therapy
Microwave Therapy, 97020 ?with Exercises, 97113

CPT only ©2003 American Medical Association. AH Rights Reserved.

©2003 ingentx, inc.
ICD-9-CM Definitions and Guidelines

The Intemational Classificationo f Diseases, Ninth Revision, The Structure of ICD-9-CM

Clinical Modification (ICD-9-CM) isa classification system T h e I C D - 9 - C M system contains t w o classifications, o n e f o r
in which diseases and injuries are arranged in groups of diseases a n d t h e other f o r procedures. It consists o f three
related cases for statistical purposes. Based on the World volumes:
Health Organization?s (WIIO) Intemational Classification
© Volume 1, Diseases: Tabular List
of Diseases, the ICD system has been revised periodically to
meet the needs of statistical data usage. In the United © Volume 2, Diseases: Alphabetic Index
States, the system has been expanded and modified (-CM)
* Volume 3, Procedures: Tabular List and Alphabetic
to meet unique clinical purposes. Clinical uses include Index
indexing medical records, facilitating medical care reviews,
and completing reimbursement claims. Volume 3, Procedures, is used primarily for inpatient
coding, The physician office, outpatient clinics, or
The responsibility for maintenance of the classification ambulatory surgery centers coding staff should use the CPT
system is shared between the National Center for Health
system for coding procedures. Therefore, only Volume 1

Statistics (NCHS) and the Centers for Medicare and

{Tabular List) and Volume 2 (Alphabetic Index) of
Medicaid Services (CMS). These two organizations co-chair ICD-9-CM are used in the physician office for assigning
the ICD-9-CM Coordination and Maintenance Committee,
diagnosis codes. For this manual, only physical therapy
which meets twice a year in a public forum ¢o discuss related index entries are listed.
revisions to the classification system. Final decisions
concerning any revisions to the system are made by the
director of NCHS and the administrator o f CMS. Once The Structure of the Alphabetic Index
The Alphabetic Index of (CD-9-CM, commonly referred to
determined, the final decisions are published in the Federal
as the Index, is used in the first step in assigning a code.
Register and become effective October 1o f each year.
The Index is divided into three sections: the ?Alphabetic
The ICD-9-CM coding system is a methodof translating Index to Disease and Injury,? the ?Table of Drugs and
medical terminology for diseases and procedures into Chemicals," and the ?Alphabetic Index (o External Causes
codes. Codes within the system are either numeric or of Injury and Poisoning.? For this book, physical therapy
alphanumeric and are made up of three, four, or five related index entries are listed.
characters. A decimal point follows all three-character codes
when fourth and fifth characters are required. ?Coding? Alphabetic Index t o Diseases and Injuries
involves using a numeric or alphanumeric code to describe Included i n this section is an alphabetic list of diseases,
a disease or injury. For example, frozen shoulder is
injuries, symptoms, and other reasons for contact with the
tanslated into code 726. physician. This section also contains two tables that classify
Although hospitals and other health care facilities have hypertension and neoplasms.
used ICD-9-CM codes for many years, health care provider
offices are also required to use ICD-9-CM codes for all Table o f D r u g s and C h e m i c a l s
Medicare billings. Thus, it is essential that coding staff, The drugs and chemicals that are the external causes of
regardless of setting, become more knowledgeable, poisoning and other adverse effects are organized in table
proficient, and accurate in their use of the ICD-9-CM format. Specific drugs and chemical substances that the
diagnosis coding system. By improving coding skills, patient may have taken, or been given, are listed
appropriate reimbursement, and efficient claims processing, alphabetically. Each of these substances is assigned a code 9
coders limit audit liability and decrease the number of to identify the drug as a poisoning agent, resulting from rs

denied claims and requests for additional information. incorrect substances given, incorrect dosages taken, 3
overdose, or intoxication. The five columns titled, External 3
This chapter provides information on the structure of $
EA
Cause, list E codes for external causes depending upon i f
ICD-9-CM. We have also identified coding tips and the circumstances involving the use o f the drug were
guidelines for the ICD-9-CM chapters that are pertinent to
accidental, for therapeutic use, a suicide attempt, an assault,
the physical therapy provider.
or undetermined.

Coding Tip
Alphabetic Index t o External Causes of Injury
Be sure that your ICD-9-CM coding system contains
a n d P o i s o n i n g (E C o d e s )
the most up-to-date information available. Changes
This section is an a l p h a b e t i c list o f e n v i r o n m e n t a l events,
take place October 1 of every year, and your code
circumstances, and o t h e r c o n d i t i o n s t h a t can cause i n j u r y
book must be current to ensure accurate codin|
a n d adverse effects.

©2003 ingentx, inc.

Coding a n d P a y m e n t Guide for the Physical Therapist

Benign neoplasms are those found not to be cancerous in and, therefore, appear together in these guidelines without
nature. The dividing cells adhere to each other in the tumor distinguishing one from the other.
and remain a circumscribed lesion. Neoplasms of uncertain
Though the conventions and general guidelines apply to all
behavior are those whose subsequent behaviour cannot settings, coding guidelines for outpatient and physician
currently be predicted from the present appearance of the
reporting of diagnoses will vary in a numbero f instances
tumor and will require further study. Unspecified indicates
from those for inpatient diagnoses, recognizing that: 1) the
simply a lack of documentation to support the selection of
Uniform Hospital Discharge Data Set (UHDDS) definition
any more specific code.
of principal diagnosis applies only to inpatients in acute,
short-term, general hospitals, and 2) coding guidelines for
Manifestation Codes
inconclusive diagnoses (probable, suspected, rule out, etc.)
As in the following example, when two codes are required
were developed for inpatient reporting and do not apply to
to indicate etiology and manifestation, the manifestation
code appears in italics and brackets. The manifestation code outpatients.
is never a principal/primary diagnosis. Etiology is always A. Selection o f first-listed c o n d i t i o n
sequenced first.
In the outpatient setting, the term ?first-listed
Arthritis, arthritic (acute) (chronic) diagnosis? is used in lieu of principal diagnosis.
due to or associated
with enteritis NEC 009.1 {711.3} In determining the first-listed diagnosis, the coding
conventions of ICD-9-CM, as well as the general and
Official ICD-9-CM Guidelines f o r disease-specific guidelines, take precedence over the
Coding and Reporting outpatient guidelines. Diagnoses often are not
The Public ITealth Service and CMSo f the U.S. Department established at the time of the initial encounter/visit. It
of Health and Iuman Services (DIIIIS) present the may take two or more visits before the diagnosis is
following guidelines for coding and reporting using confirmed.
ICD-9-CM. These guidelines should be used as a companion
The most critical rule involves beginning the search for
document to the official versions of the ICD-9-CM.
the correct code assignment through the Alphabetic
These guidelines for coding and reporting have been Index. Never begin searching initially i n the Tabular
developed and approved by the cooperating parties for List as this will lead to coding errors.
ICD-9-CM: American Hospital Association, American
Health Information Management Association, and the
B. The appropriate code or codes from 001.0 through
National Center for Health Statistics. These guidelines 83.89 must be used to identify diagnoses, symptoms,
conditions, problems, complaints, or other reason(s}
appear i n the second quarter 2002 Coding Clinic for
for the encounter/visit.
ICD-9-CM, published by the American Hospital
Association, where they are updated regularly. C. For accurate reporting of ICD-9-CM diagnosis codes,
These guidelines have been developed to assist the user in the documentation should describe the patient's
condition, using terminology which includes specific
coding and reporting in situations where the ICD-9-CM
book does not provide direction. Coding and sequencing diagnoses as well as symptoms, problems, or reasons
for the encounter. There are ICD-9-CM codes to.
instruction in the three ICD-9-CM volumes take precedence
describe all of these.
over any guidelines.
These guidelines are not exhaustive. The cooperating parties D. The selection o f codes 001.0 through 999.9 will
are continuing to conduct review of these guidelines and to frequently be used to describe the reason for the
encounter. These codes are from the section of
develop new guidelines as needed. Users of ICD-9-CM
ICD-9-CM for the classification of diseases and injuries
should be aware that only guidelines approved by the
{eg,, infectious and parasitic diseases; neoplasms;
cooperating parties are official. Revisions of these
guidelines and new guidelines will be published by the symptoms, signs, and ill-defined conditions, etc.).
DHIIS when they are approved by the cooperating parties. E. Codes that describe symptoms and signs, as opposed

Diagnostic Coding and Reporting Guidelines

to diagnoses, are acceptable for reporting purposes.
whena diagnosis has not been established (confirmed)
for Outpatient Services (Hospital-Based and
by the physician. Chapter 16 of ICD-9-CM, Symptoms,
Physician Office)
Signs, and Ill-defined Conditions {codes 780.0-799.9}
These coding guidelines for outpatient diagnoses have been
contains many, but not all, codes for symptoms.
approved for use by hospitals and physicians in coding and
reporting hospital-based outpatient services and physician
FE
__ ICD-9-CM provides codes to deal with encounters for
office visits. circumstances other than a disease or injury. The
Supplementary Classification of Factors Influencing
The terms ?encounter? and ?visit? are often used Health Status and Contact with Health Services
interchangeably in describing outpatient service contacts {V01.0-V83.89) is provided to deal with occasions

Unspecified EA
132 ? S i & gsymptoms
n s BB Codes that require a fitth-digit ©2003 ingentx, inc.
HCPCS Level Il Index

Abdomen /abdominal Carex

dressingholder/binder, A4462 aluminum crutches, E0114
cane, E0100
Abdominal binder
elastic, A4462 folding walker, E0135
Abduction Cervical
collar, LO120, LO150
pillow, E1399 halo, LOS10
Absorption dressing, A6251-A6256 orthosis, L0120, L0140-L0174
Accessories traction equipment, not requiring frame, E0855
ambulation devices, E0153-E0159 Chair
beds, E0277-E0280 shower or bath, E0240
Adhesive Chin
pads, A6203-A6205, A6212-A6214, A6237-A6239 cup, cervical, LO150
remover, A4455
Cida
tape, A4452
exostatic cervical collar, L0140
Algiderm, alginate dressing, A6196-A6199 form fit collar, LO120
Alginate dressing, AG196-A6199 Cleaning solvent, Nu-Hope
16 oz bottle, A4455,
Algosteril, alginate dressing, AG196-A6199 4 oz bottle, A4455
Ambulation device, E0100-E0159
Collagen
Ambulation stimulator wound dressing, A6021-A6024
spinal cord injured, KO600
Collar, cervical
Anterior-posterior orthosis, L0530 contour (low, standard), LO120
lateral orthosis, LO520 nonadjust (foam), L0120
Apnea monitor, Philly? One-piece? Extrication collar, LO150
electrodes, A4556 tracheotomy, L0172
Philadelphia? tracheotomy cervical collar, LO172
Arm
sting Composite dressing, AG203-A6205
deluxe, A4565 Compression bandage
mesh cradle, A4565 high, A6452
universal light. A6448
arm, A4565 medium, A6451
elevator, A4565,
Compression
Auto-Glide folding walker, E0143 burn garment, A6501-A6506, A6509-A6512
Back supports, L0500-1.0540, L0600-L0620, L0810, LO861 stockings, 18100-18190, 18200-18230
Baseball finger splint, A4570 Conductive
garment (for TENS), E0731
Bath chair, £0240 paste or gel, A4558
Battery, Conforming bandage, A6442-A6447
TENS, A4630
Contact layer, A6206-A6208
Bed
cradle, any type, E0280 Corset, spinal orthosis, L0970-L0976
Bell-Horn Cover, wound
sacracinch, LO510 alginate dressing. AG196-A6198
collagen dressing,
Belt foam dressing. A6209-A6214
extremity, E0945 hydrocolloid dressing, A6234-A6239
pelvic, E0944 hydrogel dressing, A6242-A6248
Binder specialty absorptive dressing, A6251-A6256
extremity, nonelastic, A4465 Cradle, bed, E0280
lumbar-sacral-orthosis (LSO}, A4462
Crutch
Biofeedback device, E0746 substitute, E0118
Body jacket Crutches, £0110-E0116
lumbar-sacral orthosis (spinal), L0500-L0540, L0610 accessories, A4635-A4637
Body Wrap aluminum. £0114
foam positioners, E0191 articulating, spring assisted, E0117
therapeutic overlay, E0199 forearm, EO111
Ortho-Ease, E0111
Boot
underarm, ather than wood, pair, E0114
pelvic, E0944 Quikfit Custom Pack, E0114
Brake attachment, wheeled walker, E0159 Red Dot, E0114
underarm, waod, single, E0113
Burn garment, AG501 Ready-for-use, E0113
Cane, E0100 wooden, £0112
accessory, A4636-A4637
Curasorb, alginate dressing, A6196-AG199
Easy-Care quad, E0105
quad canes, E0105 Cushion
Quadri-Poise, E0105 decubitus care, E0190
wooden canes, E0100

©2003 ingentx, inc.

Correct Coding Initiative

* Indicates a m u t u a l l y exclusive edit 0018T 90802*-90857°, 90862, 9 0 8 6 5 - 9 0 8 7 1 ,

90880°
OO01F No CCI edits apply to this code.
0019T 0020T, 76880, 7 6 9 7 7 - 7 6 9 9 9
ooo1T O002T*, 3 4 8 0 0 ° - 3 4 8 0 4 ° , 3 6 0 0 0 , 36410,
90780 0020T 76880, 76977-76999

0002F No CCI edits apply to this code. 0021T 36000, 36410, 9 0 7 8 0

0003F No CCI edits apply to this code. 0023T N o CCI edits a p p l y t o t h i s code.

0003T No CCI edits apply to this code. 0024T 33210-33211, 3 3 2 3 4 - 3 3 2 3 5 , 3 5 2 0 1 - 3 5 2 0 6 ,

35226, 3 5 2 6 1 - 3 5 2 6 6 , 3 5 2 8 6 , 3 6 0 0 0 , 36010,
0004F No CCI edits apply to this code.
36013-36014, 36120-36140, 36410, 36600-
O00SF No CCI edits apply to this code. 3 6 6 4 0 , 3 7 2 0 2 , 71034, 7 6 0 0 0 , 9 0 7 8 0 , 9 3 5 4 0 ,
93545-93556
000ST 35201-35206, 35226, 35261-35266, 35286,
36000, 36410, 36620-36625, 37202, 37205*, 0026T 80500-80502
69990, 76000, 76003, 76360, 76393, 76942,
0027T 0 0 6 0 0 - 0 0 6 2 0 , 00630, 00670, 3 6 0 0 0 , 36410,
90780
37202, 62281-62284, 62310-62319, 64415-
O006F No CCI edits apply to this code. 64417, 64450-64470, 64475, 64479, 64483,
64722, 69990, 72265, 72275, 76000, 76003-
o006T No CCI edits apply to this code.
76005, 90780
0007F No CCI edits apply to this code.
0028T N o CCI edits a p p l y t o t h i s code.
0007T 35201-35206, 35226, 35261-35266, 35286,
0029T 90901*-90911°, 9 7 5 3 0 , 9 7 5 3 3
36000, 36410, 37202, 76360°, 90780

0030T N o CCI edits a p p l y t o t h i s code.

0008F No CCI edits apply to this code.
0031T N o CCI edits a p p l y t o t h i s code.
0008T 00740, 00810, 36000, 36410, 43200, 43202-
4 3 2 3 5 , 4 3 2 5 5 , 69990, 89130, 9 0 7 8 0 - 9 0 7 8 4 , 0032T 0031T
91105, 9 4 7 6 0 - 9 4 7 6 1
0033T 01926, 3 6 0 0 0 , 36410, 3 7 2 0 2 , 62318-62319,
0009F No CCI edits apply to this code. 64415, 64417, 64450-64470, 6 4 4 7 5 , 69990,
90780
0009T 36000, 36410, 57100, 57180, 5 7 4 0 0 - 5 7 4 1 0 ,
57452, 57500, 57530, 57800, 58100-58120, 0034T 01926, 3 6 0 0 0 , 36410, 3 7 2 0 2 , 62318-62319,
58353°, 58558, 58563°, 64435, 69990, 64415, 64417, 6 4 4 5 0 - 6 4 4 7 0 , 6 4 4 7 5 , 69990,
76362, 76394, 76490, 76942, 76986, 90780 90780

O010F No CCI edits apply to this code. 0035T 01926, 3 6 0 0 0 , 36410, 3 7 2 0 2 , 62318-62319,
64415, 64417, 64450-64470, 6 4 4 7 5 , 69990,
oo10T No CCI edits apply to this code.
90780
Oo11F No CCI edits apply to this code.
0036T N o CCI edits a p p l y t o t h i s code.
0012T 29870-29871, 29874-29875, 29877-29879,
0037T 36000, 36410, 3 7 2 0 2 , 62318-62319, 64415,
29884, 2 9 8 8 6 - 2 9 8 8 7 , 36000, 36410, 37202,
64417, 64450-64470, 64475, 69990, 90780
62318-62319, 64415-64417, 64450-64470,
64475, 90780 0038T 01916

0013T 0012T*, 29870-29871, 2 9 8 7 4 - 2 9 8 7 5 , 29877- 0039T 01916

29879, 2 9 8 8 4 , 2 9 8 8 6 - 2 9 8 8 7 , 36000, 36410,
0040T 01916
37202, 62318-62319, 64415-64417, 64450-
64470, 6 4 4 7 5 , 9 0 7 8 0 0041T N o CCI edits a p p l y t o t h i s code.

0014T 29870-29871, 29874-29875, 29877, 29880- 0042T 01922, 3 6 0 0 0 , 36410, 9 0 7 8 0

29884, 3 6 0 0 0 , 36410, 37202, 62318-62319,
0043T N o CCI edits a p p l y t o t h i s code.
64415-64417, 64450-64470, 64475, 90780
0044T N o CCI edits a p p l y t o t h i s code.
0016T 36000, 36410, 90780
0045T N o CCI edits a p p l y t o t h i s code.
0017T 36000, 36410, 90780
0046T N o CCI edits a p p l y t o t h i s code.

@Tonly ©2003 American Medical Association. All Rights Reserved.

©2003 ingenix, inc. 277
C o d i n g a n d P a y m e n t Guide For The Physical Therapist

00471 No CCI edits apply to this code. 29505 36000, 36410, 37202,
29445°%, 29515, 29540,
04st No CCI edits apply to this code. 62318-62319, 64415-64417, 64450-64470,
64475, 69990, 90780
0049T No CCI edits apply to this code,
: :
29515 11055-11056, 29445®, 29540-29580, 36000,
00501 No CCI edits apply to this code, 36410, 37202, 62318-62319, 64415-64417,
o0siT No CCI edits apply to this code, 64450-64470, 64475, 69990, 90780
0052T No CCI edits apply to this code. 29520 29445°, 36000, 36410, 37202, 62318-62319,
64415-64417, 64450-64470, 64475, 69990,
0053T No CCI edits apply to this code, 90780

0054 No CCI edits apply to this code. 29530 12002, 29445°, 36000, 36410, 37202, 62318-
005ST No CCI edits apply to this code, 62319, 64415-64417, 64450-64470, 64475,
69990, 90780
0056T No CCI edits apply to this code, 99°
. .
29540 11900, 12004, 29445°, 29550, 36000, 36410,
00577 No CCI edits apply to this code, 37202, 62318-62319, 64415-64417, 64450-
00s8T No CCI edits apply to this code, 64470, 64475, 69990, 90780
0059T No CCI edits apply to this code, 29550 11719, 11900, 36000, 36410, 37202, 62318-
. .
62319, 64415-64417, 64450-64470, 64475,
oosor No CCI edits apply to this code, 69990, 90780, C0127

o06iT No CCI edits apply to this code. 29580 12002-12004, 15852, 29540-29550, 29700,
16020 01995, 11100, 11719, 16000*-16015*, 36000, 36410, 37202, 62318-62319, 64415-
16025*-16030°, 36000, 36410, 37202, 64417, 64450-64470, 64475, 69990, 87070,
62318-62319, 64415-64417, 64450-64470, 87076-87077, 90780
*
64475, 69990, 90780, 97022, 97601 29590 29540, 36000, 36410, 37202, 62318-62319,
16025 01995, 11100, 16015%, 16030%, 36000, 36410, 64415-64417, 64450-64470, 64475, 69990,
37202, 62318-62319, 64415-64417, 64450- 90780
64470, 64475, 69990, 90780, 97022 64550 36000, 36410, 61850*-61880*, 62318-62319,
16030 01995, 11100, 16015%, 36000, 36410, 37202, 64415-64417, 64450-64470, 64475, 69990,
62318-62319, 64415-64417, 64450-64470, 90780
64475, 69990, 90780, 97022 90901 51784-51785, 51795, 64550, 90804-90857,
29125 12001-12002, 12032, 12042-12044, 13121, 90865, 90880, 91122
13132, 29130, 29260, 36000, 36410, 37202, | gggiy 51784-51785, 51795, 64550, 90804-90857,
62318-62319, 64415-64417, 64450-64470, 50865, 90880, 90901, 91122, 98860-95879,
64475, 69990, 90780, GO168 97032, 97110-97112, 97530, 97535, 97750
29126 36000, 36410, 37202, 62318-62319, 64415- A A

64417, 64450-64470, 64475, 69990, 90780 52605 No GCI edits apply to this code.
29130 36000, 36410, 37202, 62318-62319, 64415. | 92606 No CCI edits apply to this code.
64417, 64450-64470, 64475, 69990, 90780 | 92607 No CCI edits apply to this code.
29131 36000, 36410, 37202, 62318-62319, 64415- | 92608 No CCI edits apply to this code.
64417, 64450-64470, 64475, 69990, 90780 | grgqq No CCI edits apply to this code.
29200 36000, 36410, 37202, 62318-62319, 64415- | gogig 92511
64417, 64450-64470, 64475, 69990, 90780
92611 76120-76125, 92511, 92610*
29220 36000, 36410, 37202, 62318-62319, 64415-
64417, 64450-64470, 64475, 69990, 90780 | 92950 36000, 36410, 90780, 92961°
29240 36000, 36410, 37202, 62318-62319, 64415- | 93615 36000, 36410, 90780-90784, 93000-93010,
64417, 64450-64470, 64475, 69990, 90780 93016-93018, 93040-93042, 94760-94761
29260 36000, 36410, 37202, 62318-62319, 64415- | 93016 36000, 36410, 90780-90784, 93000-93010,
64417, 64450-64470, 64475, 69990, 90780 93040-93042, 94760-94761
29280 36000, 36410, 37202, 62318-62319, 64415- | 93017 36000, 36410, 90780-90784, 93000-93010,
64417, 64450-64470, 64475, 69990, 90780 93040-93042
93018 36000, 36410, 90781-90784, 93000-93010,
93040-93042, 93278, 94760-94761, 96410

PT only ©2003 American Medical Association. All Rights Reserved.

278 ©2003 Ingentx, inc.
Index

Abdominal dressing, 220, 233 Cardiac r e h a b i l i t a t i o n , 66, 75-76, 95- C P T , d e f i n i t i o n s a n d g u i d e l i n e s , 3, 6 9 ,

A B G s , 114 96, 2 4 4 - 2 4 7 71, 7 3 , 7 5 , 77, 7 9 , 8 1 , 8 3 , 85, 8 7 ,
A B N , 1 2 - 1 3 , 15, 17, 2 1 9 , 2 2 1 , 2 6 5 , C a r d i o p u l m o n a r y resuscitation, 75, 95 8 9 , 91, 9 3
270 Cardiovascular services, 75 C P T , i n d e x , 3, 9 5 - 9 8

Abnormal findings, 108, 122 Cardiovascular stress test, 76 CPT, modifiers, 218
Action plan, 35 Casts, 7 2 , 2 5 6 Custom-fitted orthotic, 230
A c u p u n c t u r e , 13, 90, 9 5 , 2 4 4 , 2 4 7 Cast Supplies, 221 C V A , 111, 1 3 6
Acute p o l i o m y e l i t i s , 102 Category II codes, 91
Acute respiratory infections, 113 Category III codes, 91 D e b r i d e m e n t , burns, 95.
A d d - o n c o d e , 6 9 , 71, 7 3 , 7 5 , 7 7 , 79, CCL, 1 1 - 1 2 , 2 7 7 - 2 8 1 D e c u b i t u s ulcers, 245, 2 4 9 , 2 5 9
81, 8 3 , 8 5 , 8 7 , 8 9 , 91, 9 3 C e l l u l i t i s , 115, 1 3 4 , 1 4 8 , 1 6 8 , 1 7 6 , Definitions a n d guidelines, 3-4, 69-71,
A d j u d i c a t i o n , 25, 3 7 , 41, 4 6 , 4 9 , 5 8 198, 267 7 3 , 7 5 , 7 7 , 79, 81, 8 3 , 8 5 , 87, 8 9 ,
Adhesive s o l v e n t * * * * * C e r e b r o v a s c u l a r d i s e a s e , 107, 1 0 9 , 111- 51, 9 3 , 9 9 , 101, 103, 105, 107, 109,
A D L , 8 6 , 8 9 , 95, 9 7 , 2 6 9 112, 1 5 3 , 172, 1 7 8 - 1 7 9 11, 113, 115, 117, 119, 121, 1 2 3 ,

Advance beneficiary notice, 12-13, 15, Cervical, collar, 2 3 0 , 233-235, 1 2 5 , 1 2 7 , 129, 2 1 7 , 2 1 9 , 2 2 1 , 2 2 3 ,

17-18, 219, 221, 265, 270 Cervical, traction, 85, 2 2 8 , 252, 2 6 2 2 2 5 , 2 2 7 , 229, 231

Alginate dressing, 233-234, 236 C H E 111, 1 1 4 D e n i s - B r o w n e s p l i n t strapping, 73

Alzheimer's, 109, 1 3 8 , 143, 1 5 4 , 1 5 6 , Chronic obstructive p u l m o n a r y Derangement joint, 148, 159, 180,
204, 208 disease, 113-114, 1 4 6 , 2 5 2 , 2 6 2 203
APC, 6 C I M , 3, 7 2 - 7 4 , 7 6 - 7 8 , 8 4 - 8 6 , 9 0 , 2 2 0 - D e r m a t i t i s , 7 3 , 112, 115, 1 5 5 , 168,
A p p e a l s , 12, 1 9 - 2 0 , 2 3 , 4 2 - 4 6 , 2 3 7 , 221, 2 2 5 - 2 2 9 , 231, 2 3 7 - 2 6 4 2 0 3 , 2 0 7 , 210, 2 1 4
266 Circadian respiratory pattern Developmental Screening Test Il, 83
A p p l i c a t i o n , 33, 48, 72-74, 84-86, 89- recording, 78 D i a b e t e s , 8 6 , 1 0 4 - 1 0 8 , 141, 1 5 5 , 1 6 8 ,
90, 9 5 - 9 6 , 2 1 8 , 2 2 1 , 2 2 7 , 2 3 2 , 2 3 4 , Claims, adjudicator, 41 1 8 2 , 1 9 4 , 196, 2 0 1 , 2 1 3 , 2 5 5 , 2 6 3
248, 2 5 0 , 2 6 0 , 265 Claims, correction, 42 D i a t h e r m y , 85, 95, 97, 2 4 5 , 250, 2 6 0
A P T A , 1, 10, 12, 27, 8 8 Claims, processing, 2-3, 11, 19, 35, 37- D i s l o c a t i o n , 7 2 , 9 6 , 119, 123, 1 3 9 ,

Aquatic therapy, 3, 87, 95-97 67, 99, 237, 269 148, 154-155, 158-159, 162, 1 6 6 ,
A R D S , 115 C M S , 1 - 2 , 5 , 7, 1 0 - 1 2 , 15, 17, 19, 2 5 , 168, 179-181, 2 0 8 , 2 6 6 - 2 6 7 , 270,
A r t h r i t i s , 85, 102, 107, 1 1 6 - 1 2 0 , 132, 3 2 - 3 3 , 35, 38-39, 41-43, 4 5 - 4 6 , 4 9 - 272-274
134, 1 4 1 - 1 4 3 , 1 5 8 , 1 6 4 , 1 7 5 - 1 7 6 , 5 0 , 5 7 , 6 3 , 71, 8 8 , 9 9 , 1 3 1 - 1 3 2 , 2 1 7 , D i s u s e a t r o p h y , 7 9 , 119, 161, 2 4 6 , 2 4 8
181, 1 8 3 , 1 9 6 , 2 0 1 , 2 0 3 , 2 0 5 , 2 0 8 - 2 2 0 , 2 2 9 , 231, 2 3 7 - 2 3 9 , 2 6 7 , 2 6 9 - D M E , 1, 10, 4 6 - 4 7 , 6 2 , 2 2 0 - 2 2 1 , 2 2 5 ,
211, 2 1 3 272 230-231, 234, 247, 249, 256-257,
Arthropathy, 116-118, 142, 148, 155, C M S - 1 5 0 0 , 2-3, 37, 39, 50, 54, 56-57, 259
i L 6 2 , 71, 2 7 1 Dressings, 62, 72-73, 8 9 - 9 0 , 95, 129,
ARU, 49 Coding systems, 1, 3, 217 218, 221, 247, 2 5 5 - 2 5 7 , 268
Assignment o f benefits, 37 Collection policies, 42-43 D u r a b l e medical e q u i p m e n t , 1, 6, 9-
Asthma, 1 1 3 - 1 1 5 , 143, 1 4 9 , 1 6 2 , 1 6 8 , C o m p l i c a t i o n s , 32, 8 6 , 100-101, 104- 10, 17, 46, 53, 62, 217-218, 220,
182, 2 0 2 - 2 0 5 , 2 0 8 - 2 0 9 , 2 1 4 , 2 4 4 - 107, 1 2 0 , 1 2 3 , 1 2 6 , 1 3 0 , 1 3 3 , 1 4 9 , 225, 228, 234, 248-249, 251, 2 5 6 -
245 210, 212, 2 1 4 , 2 4 6 , 2 5 8 259, 261, 2 6 8
Concussion, 124, 145, 149-156, 163,
B e l l ' s p a l s y , 79, 1 4 4 , 2 4 6 , 2 6 6 1 6 9 , 176, 2 0 9 Ecode, 107, 112, 115, 120, 125-126,
Belt, extremity, 2 3 3 Congenital anomalies, 100, 1 2 1 - 1 2 2 130
Beneficiary late filing, 45 C o n g e s t i v e h e a r t f a i l u r e , 111, 114, 1 6 2 Ear oximetry, 96
Benign neoplasm, 184-193 C o n s t a n t attendance, 71, 86, 88, 252 ECG, 76, 95, 156, 175, 245-247, 264
Biofeedback, device, 228, 2 3 3 Convulsions, 122, 140 EEG, 10, 79, 95
B i o f e e d b a c k , t r a i n i n g , 74, 9 6 , 9 8 C O P D , 113-114, 146, 157 EKG, 10, 54, 95, I11, 248, 254
B l u e C r o s s a n d B l u e S h i e l d , 6, 2 6 , 3 7 Correct C o d i n g Initiative, 11-12, 90, Electrical stimulation, 74, 79, 81, 85-
Bronchitis, acute, 113 2 6 8 , 277, 2 7 9 , 281 86, 90, 95, 97, 229, 245-248
Bronchitis, chronic, 157-158, 163, C o v e r a g e issues, 3, 5, 71, 7 4 - 7 5 , 8 5 , Electrodes, 73, 79, 81-83, 85, 149,
194-195, 212 2 3 2 , 2 3 7 - 2 3 8 , 2 4 4 , 257, 2 7 2 221, 228, 233-234, 245-248
Burns, local treatment, 72 Coverage Issues Manual, 3, 74-75, Electromyography, 69, 74, 78-83, 95-
237-238, 244, 257, 272 96, 228, 245
Calculating costs, 8 CPAP, 7 7 , 9 5 , 97, 2 5 0 , 2 6 0 Electrotherapy, 79, 246
Cane, 221, 226, 233-236, 249, 252, CPR, 7 , 9 5 , 9 7 Embolisms, 111-112
262 Encephalitis, 102, 108, 156, 176, 179-
Capitation, 8, 47, 62 182, 198

©2003 ingentx, inc.

Coding a n d P a y m e n t Guide for the Physical Therapist

EOB, 21, 46, 52 I C D - 9 - C M , definitions and guidelines, Medicare, summary notice, 46

Epilepsy, 109, 163, 168, 183, 214 3, 99, 101, 103, 105, 107, 109, 111, Medigap, 18-19, 49, 51-53, 56-57, 271
Evaluation and Management, 69-70, 113, 115, 117, 119, 121, 1 2 3 , 1 2 5 , Meningitis, 101-102, 108-109, 176,
76, 90-91, 95, 253-254, 264, 270 127, 1 2 9 179, 181
Evaluation, occupational, 96 I C D - 9 - C M , I n d e x , 3, 116, 1 2 4 , 131- Metabolic diseases, 100, 104
Evaluation, physical therapy, 84 215 Migraine, 109, 137, 144, 148, 157,
Evaluation, spirometry, 76 Ice cap or collar, 227 169-170, 180-182, 193, 195, 208-
Exercise therapy, 96, 136, 245-247 IDDM, 104-105, 1 3 8 - 1 3 9 , 141-143, 210
External counterpulsation, 246, 264 148, 1 5 5 , 1 6 8 , 1 8 1 - 1 8 2 , 1 9 3 - 1 9 4 , Motion analysis, 82-83, 96
196, 2 0 1 - 2 0 2 , 2 0 9 , 2 1 3 Multiple sclerosis, 109, 156, 244
Flat foot, 121, 206, 263 I m m u n i t y d i s o r d e r s , 100, 104, 1 0 8 Muscle testing, 79-80, 96
Foam Dressing, 222, 233-234, 236 I n c i d e n t to, 86, 2 2 9 , 2 4 4 - 2 4 5 , 2 4 8 , Muscular dystrophy, 147, 156, 161,
Foot care, 12, 15, 54, 263 253-258, 262 168, 183, 202
Foreign body, 114, 123-124, 126, 166, Independent practice, 6, 253, 262, 264 Musculoskeletal System, 72, 92, 100,
168, 177, 194, 203, 208, 265, 267 I n d e p e n d e n t Practice Association, 6 116, 137, 157, 160, 175, 196, 202
Fracture, multiple, 179 I n d e x , 3 - 4 , 9 5 - 9 9 , 104, 110, 113, 115- Myasthenia gravis, 109, 272
Fracture, skull, 123 116, 122, 1 2 4 , 126, 1 3 0 - 2 1 5 , 2 1 7 -

Fraud and abuse, 25, 33-35, 46 218, 2 3 3 - 2 3 6 N e o p l a s m , 100, 1 0 2 - 1 0 4 , 119, 129,

FIT, 122 I n f e c t i o u s & parasitic diseases, 100- 131, 136, 1 6 2 , 1 7 0 , 1 8 2 - 1 9 5 , 1 9 7 ,

F-wave, 81 102, 108, 115, 132 201, 209, 213, 2 6 7

I n s u r a n c e , 1 - 2 , 5 - 7 , 12, 1 9 - 2 3 , 2 5 - 2 6 , Neoplasm, benign, 100, 184
G a i t , t r a i n i n g , 9 , 71, 8 7 , 9 6 - 9 7 , 1 3 7 , 32, 3 7 - 3 8 , 4 0 , 42, 4 9 - 5 3 , 63, 65, 7 8 , Neoplasm, malignant, 184
270 103, 2 1 7 , 2 3 2 , 2 3 7 - 2 3 8 , 2 5 7 - 2 5 8 , N e o p l a s m , t a b l e , 103, 131
G o u t , 108, 117, 1 6 8 , 1 9 4 265-266, 268, 270-271, 2 7 3 - 2 7 4 Neoplasm, uncertain behavior, 184
Gradient compression stocking, 231 IPPB, 77, 2 5 0 - 2 5 1 , 2 6 0 Nerve c o n d u c t i o n , 78-81, 9 5 - 9 6 , 111,

Group therapy, 61, 88, 252 229

Guidelines for physical therapy K y p h o s i s , 151, 1 5 3 , 1 7 8 , 2 0 1 , 2 1 3 , 2 7 0 N e r v o u s s y s t e m , 73, 7 9 , 8 1 - 8 3 , 100,

documentation, 27 102, 106, 1 0 8 - 1 0 9 , 1 3 4 - 1 3 7 , 139-
Leukemia, 103 1 4 0 , 144, 1 4 9 - 1 5 2 , 154, 156-157,
H C P C S , Level I l l C o d e s , 2 , 3 9 , 217 Limiting charge, 18-20, 44, 48, 270 1 6 0 , 162, 1 6 5 , 1 7 5 - 1 8 2 , 1 8 4 , 187,

Health Maintenance Organizations, 5- Lordosis, 153, 180, 213 1 9 0 , 192, 2 0 2 , 2 0 8 , 2 6 5 , 2 7 2

6, 238 LSO, 230, 233-236 N e u r o b e h a v i o r a l status exam, 83

Heat, l a m p , 2 2 7 , 250, 2 6 0 Lupus, 115-116, 157, 163, 180, 183, Neurology, 69, 78, 9 6
Heat, pad, 2 2 7 , 2 3 6 199, 201, 211 N e u r o m u s c u l a r electrical s t i m u l a t i o n ,
Heel pad, 231, 2 3 4 246, 248
H e m i p l e g i a , 109, 141, 1 4 4 , 1 6 9 - 1 7 0 , Malignant neoplasm, 102, 129, 170, Neuromuscular, j u n c t i o n testing, 82
1 7 8 , 2 0 4 , 211 182-184, 195, 201, 267 Neuromuscular, reeducation, 75, 87,
Hemorrhage, subarachnoid, 138, 141, Malnutrition, 104, 1 0 7 - 1 0 8 96-97
165, 169-170 M a n i f e s t a t i o n c o d e s , 117, 1 3 2 - 1 3 3 NIDDM, 104-105, 1 3 8 - 1 3 9 , 1 4 1 - 1 4 3 ,

Hemorrhage, subdural, 169-170 M a n i p u l a t i o n , 5 4 , 78, 8 7 , 9 5 - 9 7 , 2 4 4 , 1 4 8 , 155, 1 6 8 , 1 8 1 - 1 8 2 , 1 9 3 - 1 9 4 ,

H e r p e s z o s t e r , 102, 1 1 5 264, 2 6 7 , 271 196, 201-202, 2 0 9 , 213
H I V , 9 2 , 1 0 1 - 1 0 2 , 110, 127, 1 2 9 , 1 5 7 , Manual therapy techniques, 87, 271 N o n - C o v e r e d S e r v i c e s , 15, 17, 4 7
165, 176 M C M , 3, 5 2 , 5 4 - 5 5 , 7 7 - 9 1 , 2 2 0 - 2 2 8 , Non-participating providers, 6, 12, 18,
Home management training, 87, 89 231, 2 3 7 - 2 6 4 , 2 7 1 20, 43
H o t w a t e r b o t t l e , 227, 234 Medicaid, 1, 5, 9 - 1 0 , 2 5 , 3 2 - 3 4 , 3 7 , Non-speech-generating device, 74
H u n t i n g t o n ' s c h o r e a , 109, 154, 1 7 0 45, 4 9 , 5 2 , 5 7 , 6 2 - 6 4 , 8 8 , 9 9 , 131,

Hydrocephalus, 121, 135, 137, 153, 217, 2 2 0 , 2 3 7 - 2 3 8 , 2 6 7 - 2 7 2 O I G , 25, 33-35

170, 180 M e d i c a l n e c e s s i t y , 3, 5 , 12, 15, 17, 2 5 - O p e n w o u n d s , 123-124, 270, 273
Hydrocollator unit, 227 26, 3 7 , 4 2 , 4 4 - 4 5 , 4 7 , 4 9 , 5 5 , 84, O r t h o t i c , 2 9 - 3 1 , 61, 8 4 , 8 8 , 9 0 , 137,

Hydrocolloid dressing, 223, 233-234, 87, 2 2 1 , 2 4 5 , 2 4 8 , 2 5 3 - 2 5 5 , 2 5 7 , 212, 218-219, 2 2 9 - 2 3 1 , 2 3 5 , 246,

236 2 6 4 - 2 6 5 , 2 6 8 , 271 267

Hydrogel dressing, 223-224, 233-234, Medicare, b e n e f i t notices, 46 O r t h o t i c , devices, 2 3 0 - 2 3 1 , 2 3 5 , 2 6 7

236 M e d i c a r e , C a r r i e r s M a n u a l , 3, 71, 2 3 7 - O r t h o t i c , shoes, 231

H y p e r t e n s i o n , 9 9 , 101, 116, 141, 1 4 3 , 238, 2 4 4 , 2 4 7 , 2 4 9 , 2 5 2 , 264, 271- O r t h o t i c , training, 137, 2 4 6
145, 1 4 7 - 1 4 9 , 151-154, 156-157, 272 O s t e o a r t h r o s i s , 118, 1 4 1 - 1 4 3 , 1 5 4 ,
1 6 1 - 1 6 4 , 170, 1 7 2 - 1 7 5 , 183, 2 6 2 , Medicare, O f f i c i a l Regulatory 1 5 7 , 175, 1 9 5 - 1 9 6 , 2 7 2
204-205, 207-209, 212 I n f o r m a t i o n , 3, 237, 239, 241, 243, Osteogenic stimulation, 245
H y p o t e n s i o n , 112, 1 7 5 , 1 9 8 , 211 245, 247, 249, 251, 253, 255, 257, O s t e o m y e l i t i s , 107, 116, 1 5 5 , 168,
259, 261, 263 183, 195-196, 2 7 2
Medicare, remittance advice, 22

©2003 ingenkx, inc.