Medical coding is complex. There are hundreds of diagnosis and procedural codes. Some have session time limits. Others don’t. Many can be billed concurrently, while several have add-ons. All these tiny details play a crucial role in code selection to ensure each aligns with the rendered care service perfectly for accurate reimbursements.
This guide is related to one such timed procedural code that orthopedics or therapists often use to bill a follow-up appointment. We will cover everything you need to know about the CPT code 97763 to ensure timely reimbursements and a steady cash flow for your practice.
So, without ado, let’s get started!
CPT Code 97763 – Description
This code is from the Orthotic Management and Training and Prosthetic Training range maintained by the American Medical Association (AMA). It is a timed code, and 1 unit is billed for the 15 minutes the healthcare provider spends with the patient for a follow-up visit.
97763 CPT code description reads that after the initial encounter, the clinician arranges and meets the patient in a subsequent encounter, face-to-face, to provide training on how to use a prosthetic or orthotic device for a lower/upper extremity or trunk area.
Scenarios Where CPT Code 97763 is Applicable
Here are some real-world examples where this therapy CPT code can be applied.
Brace Adjustment
Consider a patient who recently received a knee brace but experiences discomfort. Thus, he returns for a follow-up to adjust the brace’s alignment. The practitioner spends 15 minutes of face-to-face time adjusting the brace so the patient has a seamless experience. As a result, the clinician will bill one unit of the CPT code 97763.
Counseling and Education
A healthcare practitioner spent 30 minutes counseling and educating a patient with a wrist brace and experiencing discomfort and swelling. It involved a discussion on how to wear a brace properly, techniques to manage swelling, and what exercise to perform to improve motion and range. Here, the clinician will report 2 units for accurate 97763 CPT code reimbursement.
Prosthetic Leg Training
Assume a patient receives a new prosthetic leg and requires training to use it properly. Thus, in the first follow-up visit, the healthcare provider will assist the patient in practicing walking, sitting, and stair climbing. The session maybe 30 minutes long, with the first 15 minutes spent on stair climbing and the next 15 minutes for gait training. Here, the clinician will charge two units of the 97763 CPT code.
The same patient came for a second follow-up visit involving a 45-minute training session. It involved practicing walking on uneven surfaces and running. The clinician spent 15 minutes on running drills and 30 minutes on walking practice. Thus, 3 units of the CPT code 97763 will be reported for reimbursement.
Evaluation and Reassessment
Another scenario where you may apply this code is device evaluation and reassessment. For instance, if a patient has an ankle-foot orthosis (AFO) and it is not working properly, the provider may perform a 15-minute evaluation of the AFO function, alignment, and fit. Hence, 1 unit will be billed for accurate 97763 CPT code reimbursement.
97763 CPT Code Reimbursement Guidelines
Understanding the reimbursement requirements is critical to ensure you receive timely payments without falling victim to denials. Discussed below are some of the guidelines you should consider while billing the CPT code 97763:
Meticulously Track and Record Time
Since CPT 97763 is a time-based code, you should give extra care while tracking and documenting time. Note that the 15 minutes of training provision should be face-to-face, i.e., the healthcare provider should be involved directly in the training, counseling, or education. Hence, when reporting the 97763 CPT code, avoid billing the time the patient is exercising independently or when the physician is only supervising the training.
Establish Medical Necessity
Even though all insurance companies have varying reimbursement guidelines and billing policies, everyone emphasizes establishing the medical necessity and appropriateness of the performed procedure. You can do it by providing supporting documentation. Besides, the initial encounter details may help build a firm ground for the services since the CPT code 97763 is for billing the subsequent visit.
Ensure Comprehensive Documentation
You should maintain detailed documentation of all the face-to-face interventions to ensure accurate and timely 97763 CPT code reimbursement. These may include the time and date of the encounter, the specific activities performed during the session, the time spent on each activity, and the patient’s progress.
Review Payer-Specific Guidelines
Each payer has different reimbursement policies and guidelines on how each CPT code should be billed, what documentation is required, and how it will be paid. CPT code 97763 is no different. Thus, regardless of what services you will render or what code you will report, make it a habit to review the insurance company’s specific guidelines to mitigate the risk of payment delays and denials.
Summary
Here’s a quick rundown of what we discussed in this guide. We explained the 97763 CPT code description and shared some practical scenarios where you can apply this code for reimbursement, including orthotic brace adjustment, education and counseling, prosthetic leg training, device evaluation, and reassessment.
Besides, we discussed the reimbursement guidelines specific to reporting CPT code 97763, which included tracking and recording session time, establishing medical necessity, reviewing payer-specific guidelines, and ensuring detailed documentation.Hopefully, this guide will help bill precisely for the subsequent visits related to therapy, exercises, counseling, or reassessment. However, if you have trouble handling the intricate billing and time-consuming administrative tasks related to it, why not outsource? At MediBill MD, we offer tailored physical therapy billing services to help physicians turn the cash crunch into financial success.
