FROM MY PT SCHOOL NOTES · HEALTHCARE SYSTEMS · UNIT 2 · CHAPTER 06
CPT, ICD and defensible coding
06 CPT, ICD and defensible coding What makes a billed treatment code supportable?
Core ideas from class
- CPT/HCPCS describe services or procedures; ICD-10-CM codes capture diagnoses or other clinical classifications. They answer different questions on a claim.
- Know the differences between timed and untimed services, modifiers, correct-coding edits and supporting documentation.
- For Medicare Part B timed services, total the qualifying one-on-one minutes for the discipline and date, determine allowed units, then allocate those units to the services actually performed.
Think like a PT
A PT provides 20 direct minutes of therapeutic exercise and 18 of neuromuscular re-education. Under the cited Medicare rule, 38 minutes supports three units: ordinarily two exercise units and one neuromuscular unit based on remaining minutes. Confirm payer policy.
Remember
The description, minutes, skilled rationale and code must tell the same story.
2026 policy reference: See the CMS Therapy Services page for current payment and documentation rules, including 2026 KX thresholds. Coverage policy is not identical across payer, setting or state.
From my class sources: 8 coding.pdf. These are personal school notes with additional editorial context, not current legal advice, payer guidance, a coding manual, or a guaranteed reimbursement rule. Verify any current policy directly.
