Harmony Healthcare Blog

PDPM - Where are We Now Q&A: Part 3

Posted by The Harmony Team on Fri, Feb 14, 2020

Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


Question 3 of 9: In a patient with a hip fracture, is there a need to code “muscle weakness",“difficulty walking” listed by PTs? These diagnoses are usually not listed/signed by a physician.

“Physical therapy services are those services provided within the scope of practice of physical therapists and necessary for the diagnosis and treatment of impairments, functional limitations, disabilities or changes in physical function and health status.” 230.1 - Practice of Physical Therapy, Medicare Benefit Policy Manual Chapter 15 – Covered Medical and Other Health Services.

There is a difference between medical diagnosis codes and treatment codes. Medical diagnosis codes (for example M Codes) must be verified by a physician or physician extender (NP) to document that the diagnosis is present in the

  • Physician’s Orders
  • Physician Signed Listing
  • Physician’s Progress Notes

Treatment Codes should reflect the symptoms that are associated with the medical condition that a therapist is addressing. Treatment Codes represent the injury or illness being treated. R codes located in R00-R99 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) are Symptom Codes that have replaced the ICD-9 Codes in the 700 series of Codes. R Codes only require that a symptom be present that is identified by a clinician such as a therapist.

Harmony Healthcare International (HHI) recommends therapists include both the medical diagnosis and treatment codes in their documentation as both a part of their evaluations and plan of care. However, the medical diagnosis codes must be verified by a physician or physician extender while the treatment codes can be independently diagnosed by a therapist.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

 harmony20 October 29-30 2020 Encore Boston Harbor

Tags: Coding, PDPM

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