01 PM&R Overview

Physical Medicine & Rehabilitation (PM&R) Coding

Tags: specialty physiatry rehab

Definition

PM&R physicians (Physiatrists) focus on enhancing and restoring functional ability and quality of life to those with physical impairments or disabilities.

Coding Focus Areas

1. Evaluation & Management (E/M): Office visits, hospital visits, consults.
2. Physical Medicine Codes: Therapeutic procedures (often 97xxx).
3. Procedures: Injections, EMG/NCS, musculoskeletal interventions.
4. Care Coordination: Care plan oversight, team conferences.

Key Distinction

Provider Type Matters

Coding differs slightly depending on if the service is provided by:

• Physician (MD/DO): Uses E/M + Procedure codes.
• Therapist (PT/OT/ST): Uses Therapy codes + Therapy Modifiers.
• Incident-To: Therapist services billed under MD in office setting.

Physical medicine and rehabilitation (PM&R) coding requires strict adherence to specific modifiers and time-based billing rules.

Here are the core requirements:

• Discipline Modifiers: Outpatient PM&R services are not payable unless billed with -GN (Speech-Language Pathology), -GO (Occupational Therapy), or -GP (Physical Therapy) to identify the specific plan of care under which the service was delivered.
• Assistant Modifiers: You must append the -CO modifier for services furnished by an Occupational Therapy Assistant, or the -CQ modifier for a Physical Therapist Assistant.
• Medical Necessity Thresholds: The -KX modifier is required to indicate that services are medically necessary once a patient’s care exceeds standard frequency or coverage thresholds.
• Inpatient Facility Coding (ICD-10-PCS): In the hospital setting, rehabilitation procedures are classified in Section F (Physical Rehabilitation and Diagnostic Audiology), which categorizes interventions into specific root types like Motor Treatment, Speech Treatment, and Activities of Daily Living (ADL) Treatment.

00 PM&R Coding MOC