Physical Medicine & Rehabilitation Summary

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.

Would you like to review the specific rules for calculating billable units for timed vs. untimed CPT codes, or look closer at the ICD-10-PCS Section F root operations?