97110 CPT Code Physical Therapy

Touseef Riaz

April 18, 2022

97110 CPT code Physical Therapy

CPT code 97110 falls under Physical Medicine and Rehabilitation Therapeutic Procedures. 97110 CPT code physical therapy is maintained by the American Medical Association (AMA). It involves therapeutic procedures in one or more areas, every 15 minutes. According to AMA, this code involves therapeutic exercises for developing the following:

  • Strength
  • Endurance
  • Range of motion
  • Flexibility

For instance, the typical patient description for CPT code 97110 includes:

Suppose a patient shows up with decreased arm and shoulder functionality due to a rotator cuff tear. Based on this, one-on-one or direct therapeutic exercises are provided. Note that, in order to get reimbursed for the services, the medical necessity behind prescribing the procedures should be documented. There are several questions regarding CPT Code 97110; some of them are answered below:

Is CPT 97110 covered by Medicare?

Medicare covers only time spent in the documentation of services (medical record production) of the particular CPT code. CPT codes for Therapy procedures; 97110, 97112, 97113, 97116, and 97530 define various therapeutic interventions using exercise to develop strength, endurance, range of motion, and flexibility within 15 minutes.

97110 CPT code Physical Therapy

Is 97110 a physical therapy CPT code?

CPT code 97110 physical therapy is one of the most common physical therapy CPT codes. This procedure code is defined as a therapeutic procedure to develop strength and endurance, range of motion, and flexibility. It is a therapy procedure in 1 or more areas, every 15 minutes.

Other commonly used CPT codes for physical therapy include:

    • Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.
  • CPT Code 97530 
    • Use of dynamic activities to improve functional performance. Examples of such activities include lifting, pushing, pulling, reaching, throwing, etc. the provider uses various activities in direct contact with the patient to improve the patient’s functional performance. Use this code for every 15 minutes of activity.

 

Requirements of 97110 CPT Code Physical Therapy:

CPT code 97110 is for Therapeutic procedures, one or more areas, every 15 minutes. Similar to other therapeutic procedures, 15-minute CPT codes, the 8-minute rule should be used when necessary. Following are some of the basics of the 97110 CPT code for physical therapy:

Documentation for CPT code 97110:

Proper documentation is the crucial component for medical billing of all specialties. The documentation must be complete and accurate and must include the required information regarding the patient. Proper documentation plays a crucial role in patient care and medical billing. Organized and correct documentation for the services performed can help justify the procedures in case of claim denials or rejections. For documentation of CPT code 97110, the following are the requirements. The documentation must include:

  • Loss of joint range of motion, strength, and mobility. It includes:
    • Strength grades
    • Level of assistance
    • Degree of motion
  • The improvement level of these exercises is on the patient.
    • It must report “how” therapeutic exercises are helping the patient reach their measurable, objective, and stated health goals.
  • Medical necessity behind the therapeutic exercises and that they are reasonable to be performed for the following purposes:
    • Restoring functional strength
    • Improving range of motion
    • Flexibility
    • Endurance training

Direct session:

Along with medical necessity and proper documentation:

A direct one-on-one session between the physician and the patient is a requirement for therapeutic exercises. Therapeutic exercise CPT code for physical therapy is a timed code, i.e., every 15 minutes.

8-minute rule:

Medicare and Medicaid require a minimum time period for billing a treatment session. This is the reason why the physicians or healthcare providers are required to spend at least 8 minutes of a treatment session to bill one unit. The 8-minute rule was devised because not all the treatments end up for 15 minutes. Physicians should use the 8-minute rule when necessary for therapeutic procedures.

Does CPT 97110 need a modifier?

This is a common question as therapeutic exercises require a minimum of 8 minutes for a direct one-on-one session. Proper medical billing involves the use of specific modifier(s) from the physician reporting for the services they performed. For CPT code 97110, there are several suitable as well as incorrect modifiers for billing services.

First and foremost, based on the 8-minute rule, the modifier 52 cannot be used to report reduced services. Meaning if the physician performed therapeutic exercise for less than 8 minutes, they could not use modifier 52 to report it.

On the contrary, some of the modifiers that can be used with 97110 CPT code for physical therapy include:

  • Modifier GO:
    • For the procedures performed under the outpatient occupational therapy plan of care.
  • Modifier GP:
    • For the procedures performed under the outpatient physical therapy plan of care.
  • Modifier 59:
    • If another linked procedure is performed in the same visit, modifier 59 should be used. Modifier 59 reports that a procedure is distinct and independent of the other service performed on the same day, i.e., distinct procedural service.

What are CPT codes in medical coding?

CPT stands for Current Procedural Terminology (CPT). It offers physicians, healthcare providers, and professionals a uniform language for medical billing procedures. It helps streamline the medical billing, coding, and reporting as well as increase accuracy and efficiency. Following are the services that can be reported using CPT codes:

Types of CPT codes:

CPT codes are divided into several types. Including:

  • Category I:

These are the most commonly used codes by medical coders to report services and procedures. Category I codes are five-digit numeric codes only. These codes range from 00100 to 99499.

  • Category II:

This category comprises codes for performance measurement. Category II codes are supplemental tracking codes. These alphanumeric codes comprise four digits ending with an “F.” These codes are optional, meaning they are not required for proper medical coding.

Category II codes are further divided into:

  • Composite Measures
    • 0001F-0015F
  • Patient Management
    • 0500F-0575F
  • Patient History
    • 1000F-1220F
  • Physical Examination
    • 2000F-2050F
  • Diagnostic/Screening Processes or Results
    • 3006F-3573F
  • Therapeutic, Preventive or Other Interventions
    • 4000F-4306F
  • Follow-up or Other Outcomes
    • 5005F-5100F
  • Patient Safety
    • 6005F-6045F
  • Structural Measures
    • 7010F-7025F
  • Category III:

This 97110 CPT code for physical therapy and other rehab codes comprises temporary codes for emerging technology, procedures, and services. They are alphanumeric codes, i.e., four digits ending with a “T.”

Errors in medical coding:

Revenue cycle management is the backbone of any healthcare practice. Several errors are associated with medical billing and coding. Even a minor mix-up in codes can lead to claims being denied or rejected. This affects the revenue cycle and reimbursements of the healthcare practice and physicians. Following are some of the most common medical coding errors:

  • Use of incorrect code:

CPT code set is maintained by American Medical Association (AMA). These codes are updated annually; new ones are added, and some are deleted. Inputting a wrong digit or alphabet, using an outdated code, or even a minor mix-up in medical coding can result in the claim being denied. This is why healthcare practices should be up-to-date regarding all the changes in codes and guidelines.

  • Use of incorrect modifier:

Modifiers provide additional information about the medical service or procedures performed by the physician. Note that a modifier should not change the meaning of the code being used in medical billing. An incorrect modifier or missing modifier is one of the most common medical coding errors. If the correct modifier is not used, it can result in the claims being denied or rejected, directly affecting the revenues of healthcare practice.

  • Upcoding:

It is known as upcoding when a more complex or expensive/comprehensive procedure is billed than the one actually performed. This medical billing error is an unethical practice and Medicare abuse, resulting in higher reimbursements.

  • Unbundling:

Unbundling is a fraudulent practice in medical billing (similar to upcoding). It is one of the most common medical billing errors. It involves the use of separate codes for reporting a medical procedure when a single comprehensive code exists. Using different codes results in higher reimbursements from the insurance carriers. However, unbundling is an unethical practice and Medicare abuse that can result in civil liability for healthcare providers.

  • Under coding:

Under coding in medical billing includes not using codes of all the procedures performed or billing lesser codes. This can often happen due to oversight but can also be done intentionally by the providers. Under coding results in loss of revenues as physicians or providers are not reimbursed for all the services they performed. Therefore, late payments and a lower reimbursement rate.

  • Incorrect or incomplete documentation:

Documentation for the 97110 CPT code for physical therapy is a critical component in revenue cycle management (RCM). There are several reasons why complete and correct patient documentation and medical information are necessary.

  1. The medical billing professionals can accurately choose the specific and correct codes with complete and accurate documentation.
  2. Along with proper medical coding, documentation consists of the medical necessity behind the procedure performed. And it plays a vital role in case of claim denials and audit situations.

Therapeutic Exercises:

There are various exercises and activities included in the therapeutic exercises like exercises focusing on:

  • Strength
  • Endurance training
  • Flexibility
  • Stability and balance
  • Active and passive range of motion exercises
  • Activities like treadmills and other exercising machines, as well as the use of free weights.

Therapeutic exercises aim to improve the patient’s parameters, range of motion, flexibility, and strength. These exercises comprise physical activities and movement to increase function and restore flexibility. Some of the therapeutic exercises include:

  • Passive, active-assisted, and active range of motion exercises
  • Progressive resistive exercises
  • Balance training
  • Strength training
  • Aerobic conditioning
  • Body mechanics training
  • Perceptual training
  • Developmental activities training
  • Breathing exercises
  • Agility training
  • Relaxation exercises
  • Soft tissue stretching
  • Neuromuscular education or re-education
  • Power and endurance exercises

Goal:

The goals of performing therapeutic exercises are listed below:

  • Improvement of function and strength
  • Promotion of health and wellness
  • Improve gait and coordination
  • Prevention and decreased risk of reinjury

Benefits of therapeutic exercises:

Physical therapists or physicians work with patients one-on-one to perform a wide range of therapeutic exercises. These exercises come with several benefits, including:

  • Improved blood circulation
  • Mobilize joints
  • Improved the respiratory capacity
  • Restore the posture
  • Reduce rigidity
  • Increase the strength
  • Help the heart, lungs, and the overall health
  • Increases the range of motion
  • It helps in pain reduction

All of these are covered by the 97110 CPT code for physical therapy.

Frequently Asked Questions (FAQs)

  1. What is 97110 CPT code physical therapy in medical billing?

CPT code 97110 falls under Physical Medicine and Rehabilitation Therapeutic Procedures. This CPT code is maintained by the American Medical Association (AMA). CPT code 97110 physical therapy involves therapeutic procedures in one or more areas, each 15 minutes.

  1. What are the common 97110 CPT code physical therapy errors?

Several errors are associated with medical billing and coding leading to claim denials and rejections. Some of the most common medical coding errors in CPT code 97110 include:

  • Using an incorrect modifier, i.e., modifier 52, in case of treatment session less than 8 minutes.
  • Using an incorrect code
  • Incomplete documentation, e.g., medical necessity isn’t specified or incorrect patient details.
  1. How do you prevent 97110 CPT code physical therapy errors?

Medical billing and coding errors can be avoided in the 97110 CPT code for physical therapy by following the payer’s requirements, using the correct codes, and completing and accurate documentation. CPT code 97110 physical therapy requires:

  • Complete documentation including medical necessity, improvement, progress, and reason behind the therapeutic exercise.
  • Using the correct modifier
  • Therapeutic exercise must be a direct one-on-one session with the patient.

https://www.aapc.com/codes/cpt-codes/97110

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