Billing & Coding in Occupational Therapy:
What is ICD-10 Codes?
- ICD 10 stands for International Classification of Disease- Tenth Edition
- ICD-10 codes are used for billing purposes in occupational therapy to classify different diagnosis
- Common ICD-10 codes that are used in pediatric occupational therapy include:
- 81: Muscle weakness (generalized)
- F82: Specific developmental disorder of motor function
- 8: Other lack of coordination
- 3: Feeding Difficulties
- 0: Delayed milestones in childhood development
- 0: Brachial Plexus disorders
- 0: Ataxia, unspecified
- 0 Dyspraxia
- 0: Autism
- 0: Attention Deficit Hyperactivity Disorder
- 0: Down Syndrome
What are CPT Codes?
- CPT stands for current procedural terminology
- CPT is a coding system that is used to report medical, surgical, and diagnostic procedures from healthcare professions
- CPT codes are used for billing both public and private insurance programs
- There are two types of CPT codes. The first type is serviced based; the code is reported without regarding the length of time spent performing the service and is billed only once per encounter regardless of the number of areas treated. The other type is time-based codes; this requires direct one-on-one patient contact and is billed based on the time providing the service
Treatment-Based Codes Commonly Used in Occupational Therapy:
- 97110 Therapeutic Exercise: this includes strengthening, endurance, flexibility, & range of motion. Examples: range of motion exercises, exercises to increase strength and endurance, stretching exercises to increase flexibility, and theraband & theraputty
- 97530 Therapeutic Activities: this involves a broad range of rehabilitation techniques that involve movement including, functional, dynamic activities, bending, lifting, carrying, reaching, catching, overhead activities & performance of functional mobility
- 97533 Sensory Integrative Techniques: this enhances sensory processing and promotes adaptive responses to environmental demands, and direct one-on-one patient contact.
- 97124 Massage: this includes stroking, compression, and percussion to promote the healing of muscles, reduce edema, improve joint range of motion, and relieve muscle spasms
- 97129 Development of Cognitive Skills: therapeutic interventions that focus on cognitive function (attention, memory, reasoning, executive function, problem-solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (managing time or schedules, initiating, organization and sequencing of tasks) with direct one-on-one patient contact
- 97112 Neuromuscular Re-Education: to improve, restore, and/or assist in the compensation for loss of balance, coordination, kinesthetic sense, posture, motor skill, and proprioception
- 97535 Self-Care/Home Management Training: includes training in activities of daily living (ADLs), compensatory training, meal preparation, safety procedures, and instructions in the use of adaptive equipment with bathing, showering, dressing, toileting/toilet hygiene, swallowing/eating/feeding, functional mobility, personal device care, personal hygiene/grooming.
- 95 Modifier: synchronous telemedicine service rendered via real-time interactive audio and video telecommunications, which is an additional code that is required to be added to the billing
CPT Codes for Evaluations:
- 97165 Low complexity Occupational Therapy Evaluation: An occupational profile/medical history and assessment that identifies 1-3 performance deficits that result in activity limitations. Typically, 30 minutes are spent face-to-face with the patient/family
- 97166 Moderate complexity Occupational Therapy Evaluation: An occupational profile/medical history and additional review of physical, cognitive, or psychosocial related to current functional performance and an assessment that identifies 3-5 performance deficits that result in activity limitation. Typically, 45 minutes are spent face-to-face with the patient/family
- 97167 High complexity Occupational Therapy Evaluation: An occupational profile and medical history which includes an extensive review of medical records and an extensive review of physical, cognitive, or psychosocial history related to current functional performance and an assessment that identifies 5 or more performance deficits that result in activity limitation. Typically, 60 minutes are spent face-to-face with the patient/family
