Know Your Codes: Guidelines for Billing Code 97112

Touseef Riaz

March 18, 2022

Billing Code 97112

What is billing code 97112 for?

Billing code 97112 is a CPT procedure code for therapeutic procedures. This billing code means neuromuscular re-education of movement, balance, coordination, and kinesthetic sense. It also includes posture and/or proprioception for sitting and/or standing activities. CPT billing code 97112 falls in chapter 11, Evaluation and Management Services of CPT coding system. 97112 comes under Physical Medicine and Rehabilitation Therapeutic Procedures. This billing code is maintained by the American Medical Association (AMA). Billing Code 97112

Guidelines for Billing code 97112:

The Current Procedural Terminology (CPT) billing guidelines mention the following points:

  • – Speech-language pathologists do not perform services coded as CPT codes 97110, 97112, 97150, or 97530 as the physical or occupational therapists perform these services.
  • – CPT codes (e.g., 97110, 97112, 97140, 97530) shall not be reported separately for services related to the canalith repositioning.
  • CMT stands for Chiropractic Manipulative Treatment.- CPT code 97112 is not separately reportable when a CMT service is also performed on the same spinal region. It also applies to other CPT codes covering Physical medicine and rehabilitation services (i.e., 97112, 97124, and 97140). Medicare covers CMT for five spinal regions.
  • – The provider or supplier is eligible to report the CPT code 97112 under Medicare if the service is being performed in a different region than CMT. It also applies to the other physical medicine and rehabilitation services (mentioned above).
  • – According to the coding guidelines, modifier 59 or XS should be used to report the above-mentioned codes and CMT.

Documentation for CPT code 97112:

As we all know, accurate and complete documentation for medical claims is a necessity. The medical claim must highlight the medical necessity of the performed procedure or service. For Medicare billing code 97112, the following are some specifics to documentation:

  • The body part being treated must be included or documented
  • The documentation must also include the specific exercises or activities being performed.
  • The purpose behind these exercises must also be documented.
  • Exercises or activities like:
  • Neuromuscular re-education of movement, balance, coordination, kinesthetic sense
  • Posture and/or proprioception for sitting and/or standing activities.

Who can code CPT 97112?

A direct one-on-one patient-physician contact is required for this procedure code. Note that CPT procedure code 97112 reflects a 15-minute interval. There is a commonly known question and the answer is no, and this billing procedure code doesn’t describe CMT (Chiropractic Manipulative Treatment). And using the wrong code to bill for the healthcare services performed can lead to claim denials or rejections.

What is medical coding?

The transformation of healthcare procedures, diagnosis, services, and equipment into alphanumeric codes is known as medical coding. It includes documentation, what was learned, the diagnosis, treatment plan, and the procedure performed. But why is medical coding needed? Any healthcare practice or physician’s revenue cycle depends on the proper medical coding. Documentation plays a vital role in medical coding as well as in providing safe and high-quality care in the future. Several medical procedures, diagnoses, services, and medical equipment are being used, leading to various medical codes. These codes are used by the healthcare practice and the insurance payers to understand:

  • The diagnosis of the patient
  • What was the medical necessity behind the treatment received by the patient?
  • What treatments, procedures, services, or supplies were provided to the patient?
  • Unusual circumstances that impacted the treatment methodology (if any).

On a daily basis, several medical claims are being prepared and submitted by the medical coders. They make sure to use the most specific medical code to tell the whole story of the patient’s treatment. Commonly used medical coding systems include CPT, ICD-10-CM & HCPCS Level II Classification.

What are CPT codes?

CPT stands for Current Procedural Terminology codes. Each and every CPT code is assigned to a specific procedure or service provided by a healthcare practice/physician. This coding system was created and is maintained by the American Medical Association (AMA). It is divided into several categories:

  • Category I – The most commonly used codes by medical coders to report services and procedures. These codes are five-digit numeric codes only.
  • Category II – Codes for performance measurement and data collection for quality of care and performance measurement. They are alphanumeric codes, four digits ending with an “F.”
  • Category III – This code set comprises temporary codes for emerging technology, procedures, and services. They are alphanumeric codes, four digits ending with a “T.”

What is ICD 10 codes?

ICD stands for International Classification of Diseases. ICD 10 is the 10th edition of the ICD coding system and is designed by the World Health Organization (WHO). This coding system comprises two medical code sets:

  • ICD-10-CM – International Classification of Diseases, 10th Revision, Clinical Modification
  • ICD-10-PCS – International Classification of Diseases, 10th Revision, Procedure Coding System.

ICD 10 codes comprise 3 to 7 characters, with the code beginning with an alphabet. The ICD 10 codes provide more detailed classification and specificity than ICD-9-CM.

What are HCPCS codes?

HCPCS stands for Healthcare Common Procedure Coding System, commonly referred to as HCPCS Level II Classification. It involves:

  • Medical devices
  • Supplies
  • Medications
  • Transportation services
  • And any other items or services

This code set is for healthcare physicians, providers, and medical equipment suppliers.

Why is correct medical coding necessary?

As mentioned earlier, medical coding plays an important role in the revenue stream of any healthcare practice. For this reason, correct medical coding is necessary. As the use of the wrong CPT or other codes can result in the claim being denied or rejected. This directly impacts the revenue cycle, as claim denials lead to:

  • Late payments
  • Lesser reimbursement rate
  • Lower revenues
  • Possible audits

Therefore, medical billers and coders must prepare and submit clean claims for faster payments.

What is Neuromuscular Re-Education?

This is a therapeutic treatment, a manual technique used by physical therapists. Neuromuscular Re-Education aims to restore body function and reduce impairments. This therapeutic treatment comprises: – Manual techniques like PNF. – Activities for balance – Re-developing normal movement patterns via therapeutic exercises (specifically designed for this). – Activities for core control Muscles and nerves can grow weaker and get negatively affected due to an injury to them from a trauma or a medical condition. Physical therapists use several techniques and exercises to improve coordination and help the muscles regain strength. This method works on retaining normal voluntary body movements.

Types of exercises:

Movement patterns can be affected by certain injuries, medical conditions, postures, and someone’s unhealthy biomechanics. There are several functional, stretching, balancing, and strengthening exercises associated with neuromuscular re-education. The goal is to focus on joint movement and positioning, including: – Optimizing biomechanics of the joint – Pain reduction – Restoring mind and body coordination – Restore natural movement patterns. – Improve balance and posture Some of the commonly performed exercises by physical therapists include: – Balance exercise (while standing) – Stability exercise (while sitting) – Isometrics for muscle contractions – PNF – Proprioceptive Neuromuscular Facilitation

What is Proprioceptive Neuromuscular Facilitation?

Proprioceptive Neuromuscular Facilitation (PNF) consists of a wide range of physical therapy techniques. This technique uses scientific principles to understand the neuromuscular system. The goal is to learn how it stimulates the muscles in order to fire up the ones we want and inhibit the others. For instance, muscles come in pairs, also known as “antagonistic pairs.” It means if one muscle contracts, the pair relaxes. The simple mechanics behind PNF is to “trick” the muscles by engaging the antagonistic pair muscle. The ultimate goal is to relieve pressure and force the other muscle to relax.

Conditions that can be treated by Neuromuscular re-education:

Neuromuscular Re-Education exercises can play a vital role in improving postural related several conditions, including pain. This can result in the prevention of repetitive injuries related to strains. Along with postural problems, neuromuscular re-education can also help: – People with poor blood circulation – Individuals under emotional stress – People with improper movement patterns: o Bad posture o Imbalances in the length o Not enough knowledge of biomechanics Neuromuscular re-education therapeutic treatment can benefit people who are suffering from chronic pain (e.g., due to an old injury). This method is especially more beneficial for these people as it helps them “regain or re-learn” energy-efficient ways to move.

Benefits of Neuromuscular Re-Education:

First and foremost, the major benefit of this therapeutic treatment is that it helps regain natural body mechanics. It also helps restore the brain-to-body connection. This treatment requires firm pressure from the professional healthcare physician at the impaired movement areas. This can be done by releasing pressure to relieve pain and improve the range of motion. Neuromuscular Re-Education can improve: – Control over posture – Proprioception – Natural movements – Coordination between mind and body – Muscle strength

Billing for Neuromuscular Re-Education:

Note that code 97112 billing cannot be used for chiropractic manipulative treatment (CMT). It is also mentioned in the official guidelines provided by Medicare for 2022. It can be used under Medicare if the service is being performed in a different spinal region than CMT. Modifier 59 or XS should be used for the neuromuscular re-education to report a separate region than CMT service.

Frequently Asked Questions (FAQs):

1. What is the billing code 97112 in medical billing?

Billing code 97112 is a CPT procedure code for therapeutic procedures. This billing code means neuromuscular re-education of movement, balance, coordination, and kinesthetic sense. It also includes posture and/or proprioception for sitting and/or standing activities.

2. What are common billing code 97112 errors?

One of the most common coding errors in the therapeutic procedure is code 97112 billing. Note that in order to permit a patient to sit or stand requiring skilled intervention, there must be a neuromuscular problem. The CPT guidelines provide detailed guidance on where not to use it.

3. What is the denial billing code 97112?

Using an incorrect code or modifier can lead to claim denials. A higher claim denial rate can lead to late payments, lost revenues, a lower reimbursement rate, and possible audits. For this reason, following the CPT guidelines using the right codes and modifiers are necessary. According to the CPT guidelines, modifier 59 or XS should be used for billing code 97112.

4. What does bill code 97112 mean?

CPT billing code 97112 falls in chapter 11, Evaluation and Management Services of CPT coding system. 97112 billing code is maintained by the American Medical Association (AMA). A direct one-on-one patient-physician contact is required for this procedure code. https://www.cms.gov/files/document/chapter11cptcodes90000-99999final11.pdf

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