CPT© (Current Procedural Terminology) coding is the means by which the vast majority of health care providers receive payment. Although physical therapists (PTs) frequently use CPT codes, they aren't necessarily familiar with the process by which the codes are developed, approved, adopted, valued, modified, and deleted. Understanding CPT codes, what they represent, and how precisely they do or do not translate into actual payment is an important aspect of physical therapist practice.
PT coding is not simply an administrative task. It represents the level and intensity of care provided by the PT. In their 2006 book Redefining Health Care, Michael E. Porter and Elizabeth Olmstead Teisberg defined value as outcomes over cost. With the American health care system moving toward value-based care and payment models, PTs must be able to provide objective information for both the numerator and denominator in Porter and Teisberg's equation.
If a PT does not understand coding—and thus does not ensure billing of the codes that most specifically and accurately represent the provided care—that PT risks inaccurate reimbursement, denials, recoupment of payments, and even investigation for fraud and abuse.