CPTeach: Can PTs Bill for Patient Education?

Patient education is the cornerstone of physical therapy care. Whether they’re demonstrating exercises or providing information patients can use to improve their own health, PTs are just as much educators as they are caregivers. However, billing for education time isn’t exactly a clear-cut process. After all, there’s no specific code for patient education. Fortunately, if you document and report codes the right way, you can ensure payment for the time you spend coaching and educating your patients. Here’s how:

What is “patient education?”

Before you can accurately report education time, it’s important to understand what, exactly, payers consider patient education. The American Physical Therapy Association (APTA) defines patient education as “the process of informing, educating, or training patients/clients, families, significant others, and caregivers with the intent to promote and optimize physical therapy services.” Instruction is essential to the physical rehabilitative process and may be administered throughout the entire plan of care. Instruction may be related to any of the following:

• the patient’s current condition;
• performance enhancement;
• potential risk of developing a problem or dysfunction;
• transitioning to a new role or setting;
• the plan of care; or
• a new wellness or fitness program.

How do therapists bill for patient education?

As I mentioned previously, there isn’t a specific CPT code for patient education. According to this article from Gawenda Seminars, “You are to bill for the time spent teaching the patient and/or caregiver the exercise program or other education provided under the CPT code that best describes what you are teaching them.” In other words, education time is included within the time the therapist spent on the associated intervention and should be reported under the service code that best aligns with what was taught.

Here's an example of how you can coach a patient on how to perform an oblique abdominal sit-up. Say you're teaching a patient how to complete an oblique abdominal sit-up to help them increase muscle strength and flexibility. In this scenario, you can bill CPT 97110 (therapeutic exercise). But, let's say you're showing this exercise to the patient to encourage dissociative movement between the thoracic and lumbar segments (and, as a result, improve proprioception). In this scenario, you can can bill CPT 97112 (neuromuscular reeducation). And finally, let's say you're showing the patient this same exercise in an effort to help improve functional ADL performance. In this scenario, you can bill CPT 97530 (therapeutic activities). Ultimately, you can wrap your education time into the service with which it most closely aligns.

Education and Training for Patient Self-Management Codes

In some cases, a PT may be able to report codes from the Education and Training for Patient Self-Management code series. These codes are only appropriate for reporting education and training for self-management of specific illnesses such as arthritis, COPD, and asthma. According to the APTA, use of these codes requires:

• “Prescription by a physician or other qualified health care professional,
• Service delivery by a nonphysician qualified health care professional, and
• Use of a standardized curriculum to teach patients/clients to effectively self-manage their established illnesses or diseases, or to delay comorbidity.”

Non-physician healthcare providers can use these codes to describe a standard curriculum for educating a patient, caregiver, or family member for up to 30 minutes. Therapists should report the code 98960 for individual patients, 98961 for groups of two to four patients, and 98962 for groups of five to eight patients. Furthermore, the curriculum must adhere to standards recognized by a physician society, the APTA, or another appropriate professional organization. The curriculum must be evidence-based, and the therapist must be able to use an outcome measurement tool to evaluate the patient’s progress. However, the provider can modify the curriculum as needed.

While Medicare bundles these codes—and many payers have followed that lead—not all payers have the same policy. So, before using these codes, be sure to verify the payer’s policy.

Other Education Codes

While other codes have the word “education” in their descriptions, payers often won’t reimburse PTs for those codes. Typically, codes for providing educational materials are bundled, and PTs should not use them to report unsupervised education time (e.g., the patient watching an instructional video).

How should physical therapists document patient education?

As explained above, the way you bill for education services typically depends on the intent of those services. So, the documentation should be super clear about the purpose of the patient education. Additionally, the documentation should:

• include detailed instructions provided to the patient;
• note the patient’s ability to learn and apply the instructions;
• demonstrate the skilled nature of the service; and
• reflect the service’s relationship to the POC.

If you’re billing the education as part of a one-on-one service, you must clearly note the instructions provided during the service. Notes must also confirm that the therapist actually performed the intervention. For example, the therapist should note that he or she selected the specific intervention, provided a demonstration, coached the patient as he or she performed the exercise, and assessed and corrected the patient’s positioning as needed.

While there’s no one-to-one CPT code for patient education, payers will still reimburse you for that time—and you should still bill for it. After all, you’re a skilled healthcare provider, and your time—as well as your knowledge—is incredibly valuable.