97150 CPT Code: Know Your CPT Codes

Introduction

In the fast-paced world of healthcare, staying on top of billing codes and guidelines is crucial. CPT code 97150, ‘Therapeutic procedure(s), group (2 or more individuals),’ is a commonly used code for physical therapists, occupational therapists, and speech-language pathologists working with multiple patients simultaneously. However, understanding its code details and proper documentation is key to accurate coding and optimal reimbursement.

Basics of 97150 CPT Code

• Description: Therapeutic procedure(s), group (2 or more individuals), untimed.
• When to use: When a physical therapist (PT), occupational therapist (OT), or speech-language pathologist (SLP) works with several patients simultaneously under their constant attention.
• Billing: Each patient in the group gets billed one unit of 97150 (97150 for PTs and OTs, 92508 for SLPs), regardless of session duration.

Note that, specific therapy codes (e.g., 97110) should not be billed in addition to 97150.

Group Therapy in Action

• Group therapy goes beyond simply supervising patients performing exercises. It involves the therapist providing:
• Introductory instructions: Tailored to each individual or the whole group.
• Constant observation and feedback: Monitoring progress, offering modifications, and ensuring safety.
• Clinical expertise: Adjusting the program as needed based on individual needs.

97150 CPT Code Example

In a 30-minute session, a PT works with three patients (A, B, and C) performing different exercises on various equipment. The therapist:

• Provides individual instructions and sets exercise parameters for each patient.
• Continuously circulates throughout the group, offering corrections and adjustments as needed.
• Briefly assist patient A with form during a challenging exercise.
• Guides patient B through balance drills, offering verbal cues and feedback.
• Monitors patient C’s progress on a treadmill, adjusting speed and incline based on their vitals.

Here, the therapist maintains constant attendance and provides skilled intervention to each patient throughout the session. Each patient would be billed one unit of 97150.

Understanding ‘Constant Attendance’

‘Constant attendance’ in 97150 implies the therapist is readily available to the group, providing ongoing supervision and guidance. Brief periods away, such as fetching equipment or addressing urgent needs, are acceptable as long as they don’t significantly impact the session’s quality.

Documentation Tips

• Focus on individual interactions: Document the specific interventions and interactions you have with each patient, not just the overall group activity.
• Time spent with each patient: Use a timer to track the approximate time you spend directly with each patient during the session.
• Avoid vague statements: Replace phrases like ‘monitored the group’ with specific details about observations and guidance provided to each individual.

Additional Billing Tips

• Review any updated CPT code changes: While the core 97150 description remains the same, 2023 revisions might impact related codes or modifiers. Stay informed!
• Consider modifiers: In specific situations, modifiers like -52 (reduced service) or -54 (multiple procedures) might be applicable. Consult your coding resources for guidance.
• Benefits of group therapy: Don’t forget to mention the potential benefits for patients, like improved social interaction, motivation, and cost-effectiveness.

By understanding the 97150 CPT code and documenting accurately, you can ensure proper billing and continue providing valuable group therapy services in 2023 and beyond.

While mastering 97150 empowers your practice, navigating complex coding can be time-consuming. For expert assistance, consider partnering with PrimeCare. Our experienced team can help ensure accurate coding, optimize your claims, and minimize denials, allowing you to focus on quality patient care. Contact PrimeCare today and let us handle the billing, so you can focus on what matters most – your patients.

References:

• Medicare Managed Care Manual Chapter 11
• American Physical Therapy Association (APTA) group therapy resources

The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. It’s important to note that CPT codes can vary over time and may be subject to updates and revisions. The AMA periodically releases new editions of the CPT code set to reflect changes in medical practices and technology, as well as updates in reimbursement guidelines.