Our Medical Billing Process

1. Patient Registration and Insurance Verification:
   • Patient Registration: We verify patient demographics, including name, date of birth, and address.
   • Insurance Verification: We verify patient insurance coverage, including the type of insurance, coverage limits, and any specific requirements or restrictions.
2. Medical Record Review and Coding:
   • Medical Record Review: We review medical records to identify all relevant services and procedures performed.
   • Coding: We assign relevant ICD-10 and CPT codes to ensure accurate billing.

Example Codes:

• Diagnosis Codes (ICD-10):
  • M25.511: Sprain of the shoulder joint
  • M25.512: Strain of the shoulder joint
  • M25.513: Dislocation of the shoulder joint
• Procedure Codes (CPT):
  • 97110: Therapeutic exercises, including therapeutic activities, to improve joint mobility and strength
  • 97112: Therapeutic exercises, including therapeutic activities, to improve muscle strength and endurance
  • 97116: Therapeutic exercises, including therapeutic activities, to improve balance and coordination

3. Claim Preparation and Submission:
   • Claim Preparation: We prepare claims using the coded information, including patient demographics, insurance information, and services and procedures performed.
   • Claim Submission: We submit claims to insurance providers electronically or on paper.
4. Claim Processing and Reimbursement:
   • Claim Processing: Insurance providers process claims, verifying services and procedures performed and patient insurance coverage.
   • Reimbursement: Insurance providers reimburse providers for services and procedures performed, based on insurance coverage and contracted rates.
5. Follow-up and Appeals:
   • Follow-up: We follow up with insurance providers to ensure claims have been processed and to address any issues or denials.
   • Appeals: If a claim is denied, we work with the provider to gather additional information and appeal the decision.

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CPT Codes for Occupational Therapy

1. Evaluation Codes:
   • 97165: Occupational therapy evaluation, low complexity
   • 97166: Occupational therapy evaluation, moderate complexity
   • 97167: Occupational therapy evaluation, high complexity
   • 97168: Occupational therapy re-evaluation
2. Treatment Codes:
   • 97537: Community/work reintegration training
   • 97542: Wheelchair management
   • 97545: Work hardening/conditioning; initial 2 hours
   • 97546: Each additional hour (List separately in addition to code for primary procedure.)
   • 97533: Sensory integrative training
   • 97540: Therapeutic activities, such as exercises, activities of daily living (ADLs), and cognitive training
   • 97542: Wheelchair management
   • 97633: Sensory integrative training
3. Modalities:
   • 97010: Application of a modality to one or more areas; hot or cold packs
   • 97018: Paraffin bath
   • 97022: Whirlpool
   • 97024: Diathermy (e.g., microwave)
4. Other Codes:
   • 97110: Therapeutic procedure, one or more areas, to develop range of motion, flexibility, strength, and endurance
   • 97116: Gait training
   • 97124: Massage
   • 97140: Manual therapy techniques
   • 97150: Group therapy

ICD-10 Codes for Occupational Therapy

1. Occupational Therapy:
   • Z71.9: Encounter for occupational therapy
   • Z71.8: Encounter for physical therapy
   • Z71.7: Encounter for speech therapy
   • Z71.6: Encounter for occupational therapy and speech therapy
   • Z71.5: Encounter for occupational therapy and physical therapy
   • Z71.4: Encounter for occupational therapy, speech therapy, and physical therapy
2. Disorders:
   • R53.8: Other disorders of the nervous system
   • R53.7: Disorders of the nervous system
   • R53.6: Disorders of the nervous system
   • R53.5: Disorders of the nervous system
   • R53.4: Disorders of the nervous system
   • R53.3: Disorders of the nervous system
   • R53.2: Disorders of the nervous system
   • R53.1: Disorders of the nervous system
   • R53.0: Disorders of the nervous system
3. Injuries:
   • S00.0: Fracture of the skull
   • S00.1: Fracture of the face
   • S00.2: Fracture of the neck
   • S00.3: Fracture of the thorax
   • S00.4: Fracture of the abdomen
   • S00.5: Fracture of the pelvis
   • S00.6: Fracture of the lower extremities
   • S00.7: Fracture of the upper extremities
   • S00.8: Fracture of the spine
   • S00.9: Fracture of the other parts of the body
4. Diseases:
   • G40.0: Cerebral palsy
   • G40.1: Cerebral palsy
   • G40.2: Cerebral palsy
   • G40.3: Cerebral palsy
   • G40.4: Cerebral palsy
   • G40.5: Cerebral palsy
   • G40.6: Cerebral palsy
   • G40.7: Cerebral palsy
   • G40.8: Cerebral palsy
   • G40.9: Cerebral palsy

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