Avoid common PMR coding errors

Published: 2009-11-01 14:50:20
Author: Michael D. Miscoe | Chiropractic Economics | March 2008

Coding can be confusing. Vague code descriptions and varying carrier rules for how and when codes should be used cause some errors.

Most coding mistakes in physical medicine and rehabilitation (PMR), however, can be traced to a fundamental misunderstanding of the difference between modalities, procedures, and contact requirements for each.


Modalities and procedures are distinct and separate as defined in the AMA CPT Manual: 

• Modalities. The AMA CPT Manual defines a modality as any physical agent applied to produce therapeutic changes to biologic tissues. Types of physical agents include, but are not limited to, thermal, acoustic, light, mechanical, or electrical energy.

Modalities are further subdivided into “supervised” and “constant attendance” modalities based on the degree of contact necessary to perform the service.

Supervised modalities (CPT 97010-97028) do not require direct one-on-one patient contact by the provider. Constant-attendance modalities (CPT 97032-97039), however, do require direct one-on-one patient contact by the provider.

You should note that the definitional requirement for direct “one-on-one” contact is somewhat of a misnomer, since you can provide constant attendance to more than one patient at a time.

To avoid problems, it is best to take a literal definition of constant attendance — that is, the provider or therapist must be in constant attendance with the patient, and such attendance is necessary for effective or safe delivery of the therapy.

• Procedures. The AMA CPT Manual defines procedure as “a manner of effecting change through the application of clinical skills and or services that attempt to improve function.”

Procedures require a physician or therapist to have direct one-on-one patient contact.

Two parts are key to distinguishing between a modality and a procedure. The first part involves a “gizmo” analysis; the second part involves reporting.

• Modality/procedure determination (gizmo analysis). If the therapy is delivered by some device (a gizmo) and the clinical skill is limited to determining the settings of the device and/or location and duration of application, the service is clearly a modality.

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