Medical Billing

# Can a Physical Therapist Bill for Occupational Therapy

- November 21, 2024
- Posted by Brian Bertrand

21 Nov

We regularly face issues regarding billing practices as healthcare practitioners, most of all when occupational and physical therapy overlap. Both are important aspects of rehabilitation, but knowing the details of billing can feel challenging yet intricate. A major common question that arises is, can a physical therapist bill for occupational therapy services?

We’ll focus on this question in this in-depth guide, give transparent information about occupational therapy billing and its codes, and clarify the hurdles and regulations. Before we wrap up, you’ll have the clarity you need to ensure organized and conforming billing for therapy offerings.

## Physical Therapy vs. Occupational Therapy: Understanding the Roles

It’s important to differentiate between physical and occupational therapy when it comes to billing practices. Yet both fields contribute to patient rehabilitation, they often address distinct needs and serve different purposes.

### Physical Therapy (PT):

Physical therapy emphasizes advancing physical role, recovering movement, and decreasing pain. In case you’re a physical practitioner, your treatments choose to help patients retrieve durability, flexibility, and self-support after an illness, injury, or surgery. For instance, physical therapy should use therapeutic exercises or manual strategies to restore a patient after knee treatment.

### Occupational Therapy (OT):

Occupational therapy centers are close to helping patients execute daily activities and regain independence. Occupational therapists work on superior motor skills, sensory processing, and versatile strategies that allow patients to handle their daily lives effectively. For instance, an OT might teach a patient with arthritis how to use specialized utensils for eating.

While these roles can overlap, their focus and methods vary, and this distinction directly impacts how services are billed.

## The Basics of Therapy Billing

Billing is an important part of therapy services, making sure that providers are refunded for their work. To help proper billing, insurance companies rely on standardized codes to identify the type of care delivered. These are multi-type codes, including CPT and ICD-10. These codes are updated by the authorities, including AMA and other insurance companies, so that every service and treatment can be billed accurately under them.

### Occupational Therapy Billing Codes

For occupational therapy, these codes specify the services provided. Common examples include:

- 97110: Therapeutic exercises targeted at enhancing adaptability, endurance, and strength.
- 97530: Therapeutic activities to promote functional performance.
- 97112: Neuromuscular reeducation to improve balance, coordination, and proprioception.

These codes are used in insurance claims to convey the sort of therapy provided. The right use of occupational therapy billing codes is critical for securing conformance and bypassing refusals.

## Can Physical Therapists Charge for Occupational Therapy Services?

The brief reply: In specific situations, yes, but with cautious measures.

There are conditions where a physical therapist can give services that are set up with occupational therapy goals. For instance, a physical therapist working in a small institution or agriculture area might deliver training on adaptive equipment or functional skills if no occupational therapist is available. However, billing for these services requires strict adherence to regulations.

### Key Considerations for Billing OT as a PT

#### 1. Licensure and Scope of Practice:

Physical therapists can only bill for occupational treatment services if they may be licensed to do so or if the service provided falls within their PT scope of practice. Licensing laws vary by state, so it’s critical to verify local policies.

#### 2. Payer Policies:

Insurance companies commonly have tough rules regarding who can bill for specific services. Before submitting claims, check the payer’s policies to confirm that billing for OT services as a PT is permissible.

#### 3. Proper Documentation:

Clear and thorough documentation is essential. Your notes should justify the need for the service, its alignment with occupational therapy goals, and the way it benefits the patient.

## Legal and Ethical Implications

Billing for services beyond your scope or licensure may result in critical consequences, including legal action, audits, or even denied claims. Ethical practice requires honesty and transparency in the services you provide and bill for.

When considering billing for occupational treatment as a physical therapist, ask yourself:

- Is this service within my professional scope of practice?
- Have I documented the service thoroughly?
- Does the payer allow me to bill for this service?

Remaining compliant with legal and ethical standards ensures your practice stays secure while providing the best care for patients.

## Common Billing Codes: A Closer Look

Several billing codes are shared between physical and occupational therapists, but how they are used depends on the context and intent of the service provided.

### Examples of Billing Codes

#### 1. 97110 (Therapeutic Exercises):

This code is used for exercises targeting strength, endurance, or range of motion. While both PTs and OTs use this code, the goals differ, PTs may focus on general physical recovery, while OTs might aim to improve specific daily tasks like lifting a coffee cup.

#### 2. 97530 (Therapeutic Activities):

This code applies to dynamic activities that improve functional performance. For instance, an OT may use it for task-specific training, while a PT might use it for activities that stimulate entire mobility.

#### 3. 97112 (Neuromuscular Reeducation):

This code focuses on improving coordination, balance, and proprioception. Both PTs and OTs can use it, but the application often reflects their distinct goals.

Using the right codes and documenting them correctly is vital for proper reimbursement.

## Challenges in Billing OT Services as a PT

While it is viable for physical therapists to bill for occupational therapy services, problems abound:

### 1. Insurance Denials:

Claims can be declined if insurance companies suspect the service falls outside the PT’s scope of practice or if documentation is insufficient.

### 2. Regulatory Restrictions:

State laws and licensing boards may impose limits on what services a PT can provide or bill for.

### 3. Confusion Between Disciplines:

Patients or insurers may question the overlap in roles, leading to additional scrutiny. Clear documentation and communication can help mitigate these concerns.

## Best Practices for Physical Therapists Billing for OT Services

To navigate these obstacles successfully, follow these best practices:

### 1. Collaborate with Occupational Therapists:

When possible, work alongside OTs to ensure patients receive specialized care. Collaboration can also clarify billing responsibilities.

### 2. Verify Payer Guidelines:

Always check with insurance providers to confirm what services they allow PTs to bill under OT codes.

### 3. Stay Within Your Scope:

Only provide services that align with your licensure and professional training.

### 4. Document Thoroughly:

Provide detailed notes on the service provided, its purpose, and its impact on the patient’s goals.

### 5. Keep Learning:

Stay informed about changes in therapy billing practices and codes.

## Documentation Tips for Seamless Billing

For therapy services, appropriate documentation is the backbone of successful billing especially when overlapping disciplines like occupational therapy and physical therapy come into play. Insurance providers may deny claims without adequate records, resulting in revenue loss or delays. Here are some essential tips to ensure your documentation supports compliant and accurate billing:

### 1. Be Specific About Services Provided:

Clearly outline the services performed, including details about the therapeutic exercises, activities, or techniques used. This information should align with the designated occupational therapy billing codes and demonstrate their relevance to the patient’s treatment plan.

### 2. Link Services to Patient Goals:

Each service documented should be tied to a measurable patient goal. For example, if you’re using code 97530 (therapeutic activities), explain how the activity enhances the patient’s ability to perform functional tasks.

### 3. Use Correct Terminology:

Ensure you’re using appropriate clinical language to describe the services. Ambiguities can lead to misinterpretations during audits or claim reviews.

### 4. Document Progress Clearly:

Highlight measurable improvements or changes resulting from the therapy. Even minor progress should be recorded to justify continued care and support billing claims.

### 5. Maintain Compliance with Payer Policies:

Tailor your documentation to meet the specific requirements of each insurance payer. Some may require additional forms or specific details about the therapy provided.

### 6. Leverage Technology for Accuracy:

Use electronic health record (EHR) systems to ensure consistent, organized, and accessible documentation. These tools can make claim submissions more effective and help avoid errors.

## Bringing It All Together

As a physical therapy practitioner, billing for occupational treatment solutions is viable, but it requests specific obedience to principled criteria, rules, and customer protocols. Knowing the function of occupational therapy billing and correctly using its codes is essential to securing successful repayment and compliance.

We advise that you approach billing with transparency, stay informed about changes in therapy billing practices, and collaborate with occupational therapists when needed. While handling the difficulties of therapy billing with confidence, you can focus on delivering exceptional care by following these guidelines.

We’re here to help if you need support in managing this complicated area or have questions about billing practices. Let’s partner up to give the best care for your patients whilst preserving compliant and righteous billing practices. Also read the comparison for choosing a chiropractor or a physical therapist for your problems.

### FAQs

### 1. Is physiotherapy part of occupational therapy?

No, physiotherapy and occupational therapy are separate areas. While they frequently work together in rehabilitation, physiotherapy prioritizes mobility and physical function, however, occupational therapy emphasizes helping patients perform everyday tasks.

### 2. Are occupational therapists physical therapists?

Occupational and physical therapists are distinct professionals with different goals, training, and roles. OTs focus on fine motor skills and functional activities, while PTs address pain management, movement, and strength.

### 3. Is 97110 a physical or occupational therapy code?

Code 97110 is a shared code used by both physical and occupational therapists. It portrays therapeutic exercises targeted at enhancing endurance, flexibility, and durability. The intent and context of the exercise determine its application in either discipline.

### 4. Is occupational therapy physical or mental?

Occupational remedy addresses each physical and mental factor of rehabilitation. OTs help patients adapt to overcome psychological barriers and develop fine motor skills, and physical challenges that impact their ability to perform daily activities.

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