Exercise Rehabilitation Coding: That Was Easy!
By Kathy (KMC) Weidner, MCS-P, CCPC, CPCO, CCCA
When billing third-party payers for exercise therapy, matching documentation descriptions to the current procedural terminology (CPT) codes can be confusing. There are numerous exercise therapy services, including stretching, strengthening, working toward more endurance, and improving range of motion. Some seem similar and overlap, but providers must always select the most appropriate code for the service.
When processing your claim, payers expect that you have differentiated between the services and presented proper coding to match the documentation. These tips will help you put your services into the right category.
Exercise Billing: 97110, 97112, or 97530?
Let’s look deeper into the proper CPT coding for exercise therapies. These codes are similar, and it is important to understand how the context and documentation define their differences. The details of these codes depend on the documentation of each, so providers must recognize the distinctions between codes as they relate to the intent behind the exercise prescription.
These are procedure codes, not modality codes, which means they are timed-based for billing. Time spent includes delivering treatment, giving the patient instructions, watching the patient’s participation, gauging the patient’s ability to complete the treatment, and noting changes in areas such as stretching, strengthening, proprioception, and breathing.
As with all therapeutic procedure codes, the patient must be active in the encounter since it requires direct one-on-one contact with the person providing the service. State scope of practice rules and payer guidelines dictate who must supervise these services, so always check with the payer’s medical review policy. Provider documentation should include the total time spent with the patient during the provision of the service and a description of the specific exercise procedures performed. Now, let’s dig into the codes themselves.
97110: Therapeutic Exercises
The primary goal of this procedure is to develop one functional parameter, such as strength, endurance, range of motion (ROM), or flexibility. Using this code may describe techniques such as a treadmill to improve endurance, isokinetic exercises to improve ROM, lumbar stabilization exercises to improve flexibility, or a stability ball to improve the patient’s flexibility or strength. Most payers will not cover routine services or those that don’t require the skill of a provider.
An example is warming up the patient on a treadmill. Although that is endurance-based, it usually will not require the presence of a provider, especially with chiropractic rehab. Therapeutic exercises are usually considered medically necessary for loss or restriction of joint motion, loss of strength or muscle wasting, decreased functional ability, or lack of mobility that resulted from disease or injury. The standard treatment protocol is 12 to 18 visits within four to six weeks. This is the most common code we expect to see rendered with typical chiropractic active care rehab.
97112: Neuromuscular Reeducation
This therapeutic procedure provides improved balance, coordination, kinesthetic sense, posture, and proprioception to a person undergoing recovery or regeneration from a multitude of injuries. The goal is to develop conscious control of individual muscles and awareness of the position of the extremities.
This procedure may be considered medically necessary for impairments that affect the body’s neuromuscular system (e.g., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity) that may be the result of disease or injury, such as severe trauma to the nervous system, cerebral vascular accidents, and systemic issues. It’s important to note that documenting the proprioceptive loss as part of the examination findings is critical for the use of this code. Likewise, the specific diagnosis should be easily derived from the findings and pointed to the service.
97530: Therapeutic Activities
This code is used when multiple parameters are trained (including balance, strength, and range of motion) to improve the patient’s functional capabilities. Providers must outline functional goals in a treatment plan related to a functional deficit where the patient is expected to improve.
Functional improvement is measured by using outcomes assessment tools (OATs). This procedure uses functional activities (e.g., bending, lifting, carrying, reaching, pushing, pulling, stooping, catching, and overhead) to progressively improve functional performance. Activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination and may require the professional skills of a provider or other trained professional.
This procedure is designed to address a patient’s specific functional needs. Once a patient has completed therapeutic exercises focused on strengthening and range of motion, it may be appropriate to progress to more function-based activities. Dynamic activities must be part of an active treatment plan and directed at a specific outcome based on the patient’s functional goal or functional deficit.
This code requires the expertise of a provider. Keep in mind that the most common use of this code is in physical or occupational therapy while retraining someone who has suffered a loss. An example is helping someone move from a wheelchair to a chair or bed. Occupational therapists also use this code when teaching someone a new activity in habilitative care. For this reason, we urge you to be careful when using this code for typical chiropractic rehabilitative care.
Low-Tech Rehab Supports Optimal Treatment Results
High-tech equipment, like exercise machines, is not always necessary to offer in-house services to patients. They tend to use a lot of floor space and often require more skilled personnel to supervise and instruct patients in their use. Low-tech rehab, like bands, balls, and body-weight exercises, is an excellent way to offer these services effectively and space-savingly. The three CPT codes that describe exercises are billed the same whether high-tech or low-tech rehab is performed.
One of the benefits of low-tech rehab is the ability to transfer these exercises to home use once the patient has been taught the exercise in the office. Providing low-tech equipment requiring minimal technical understanding lets the patient get more involved in their treatment, making them more likely to perform their at-home exercises and participate in their healing process.
Comprehensive cervical spine rehabilitation is easily trained in-office and then transferred home. Using an over-the-door unit provides an effortless way to perform prescribed exercises to enhance the effectiveness of chiropractic care. It can be used in the office and sold to patients as part of their care plan to continue treatment at home. It easily mounts over a door to save space and provides variable resistance to match the patient’s strength level. Depending on the orders in the treatment plan and the intent of the therapy, this in-office rehab may most often be described as 97110 therapeutic exercises.
Wall-mountable total-body rehab systems are extremely popular, especially when the office has limited space. This opens more possibilities for additional exercises to treat neck, back, and extremity issues — lateral flexion exercises, anterior head carriage exercises, exercises for the posterior cervical gravity line, spinal rehab exercises, anterior Ferguson’s gravity line, and exercises for the extremities and pelvis.
Depending on the orders in the treatment plan and goals for patient improvement, all three of the exercise CPT codes may be in play. A low-tech system is an easy decision for practices that want to begin offering these important rehab services but need an affordable, space-saving option.
Comprehensive Care Offered In-Office
Exercise rehabilitation is an excellent ancillary service to conservative chiropractic care. It can be accomplished with a little space, some low-tech equipment, and great training in which exercises enhance a return to normal function. Use the correct code to describe the work, outline the orders in your treatment plan, and document what was done and how the patient responded to care. Those are the building blocks of an effective and efficient active-care rehab program in your office.
About the Author
Kathy Weidner, better known professionally as Kathy Mills Chang, is a certified medical compliance specialist (MCS-P), a certified professional compliance officer (CPCO), and a certified chiropractic professional coder. Since 1983, has provided chiropractors with reimbursement and compliance training, advice, and tools to improve the financial performance of their practices. This year, Kathy celebrates serving this profession for more than 40 years while leading the largest team of certified specialists under one roof at KMC University. She is known as one of our profession’s foremost experts on Medicare and documentation, and Kathy or any of her team members can be reached at 855-TEAM KMC or [email protected].
