What CPT Code to Bill for Patient Education
Therapists and assistants often spend time with patients, a parent of a patient, or a patient’s caregiver such as a spouse, son, daughter or a hired caregiver teaching them exercises to do at home as part of a home exercise program. In addition, therapists and assistants spend time training a patient’s caregiver (i.e. parent, spouse, son, daughter) how to assist the patient with various activities outside of the clinic setting such as gait on level services, ascending/descending steps with an assistive device, dressing, bathing, bed mobility, transfers, feeding and using a speech generating communication device.
Two questions I receive concerning the above is this time I spend doing all of this billable time and if so, what CPT code do I use to bill for this time? Is there a CPT code I should be using that is specific to patient and/or family education?
To answer the first question, yes, this time is billable time as long as it
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Nice update on the specifics of billing for the education. Also thank you for informing us of getting patient ready for HEP and that it is our skills we are billing for. That is the key for therapist and assistant to remember.
Is there anything that a PT can charge in a wound care clinic when the patient presents for a follow up visit and the wound only requires a bandage change? There is no debridement done.
A dressing change would be included in CPT code 97602 and the Medicare program and every other insurance carrier I am aware of does not pay for that CPT code.
I’m in a pediatric outpatient setting. We spend quite a bit of time meeting with parents outside of patient visits to answer questions and provide therapeutic strategies or guidance. Is that billable under any insurances?
My opinion is no. There are CPT codes for family conferences, but I am not aware of any insurance company paying for them.
So in a SNF setting it would be appropriate to do the same…bill for one on one training for eg gait even if it was with a family member eg?
You would be teaching the family member how to ambulate their family member on level and/or unlevel surfaces as well as stair training.
Nice update. Can you bill for education that is skilled in nature but does not include training? Specifically may be asking about how the patient can make their home safe from falls. Thank you.
My opinion, yes, if one-on-one with the patient.
In NICU our speech therapist may not get to work on feeding skills with the infant at a due to timing (baby just calming, or vitals not stable at the moment) yet take that time in the patients room with the family teaching them what they are to look for in “readiness” to eat, their role in feeding or other nuances of specialty feeding situations. Is that a billable service?
This is not a question I answer since in this situation, you are not billing CPT codes and being paid by CPT codes. You are being paid via DRG’s.
If the NICU scenario above was in outpatient or home health, what code would be used? 92526 or 97535?
Under Home Health Part A, you are not paid via CPT codes. In outpatient therapy, if the SLP was working on feeding, diet modification, etc., this would be CPT code 92526.
Can you tell me what codes would be used when educating the patient on surgical precautions, ergonomics, joint protection and energy conservation?
Thank you,
Unfortunately, I can’t tell you which code to bill. You would have to make that determination.
Can we bill for time that a patient watched an educational DVD in the office about their condition and how to live with it?
I would say no.
Hi Rick,
I am a newer member to the site. I have a question around PT/OT billing for patient education in all settings. We are being told by our medical audit team (large hospital system) that we can’t bill for passive education activities unless the patient is “actively” participating in the education- actively demonstrating learned techniques, learned exercises, learned strategies, etc.. They are saying that education that is passive (the patient is just listening alone) is not billable. For instance, education on the importance of monitoring BP at home and making lifestyle changes to decrease stroke risk. Is this kind of passive education activity not billable?
Hi Rick
I have a similar question regarding billing for family education if the patient is not actively participating. For example, if the patient is not feeling well and is refusing to participate in therapy so they are asleep but the therapist took the opportunity to educate the family and provide them with strategies they will be able to help with upon discharge and how to navigate patient deficits but the patient was not involved really at any level other than being in the same room can they bill for that?
Not in 2023.
Where does education on the initial evaluation findings, plan of care, etc fall into billing? Is this a part of the evaluation or is this a part of a timed code? If the latter, then which code(s) as it’s not activity based education?
My opinion is if you are educating the patient on your findings, that is part of the evaluation.