Procedure Code 97112: Know Your Codes

Touseef Riaz

May 31, 2022

medical procedure code 97112

One of the significant reasons behind claim denials and a lower reimbursement rate is the use of incorrect codes. If your claims are being denied repeatedly, the use of incorrect code or inaccurate or incomplete documentation can be the reason. Resubmitting the claims and making corrections can be extremely confusing and frustrating. For this reason, understanding what CPT code to use and how to use it is crucial.

Following are the three most commonly used CPT codes for physical therapy or rehab:

procedure code 97112

Commonly used CPT codes for Physical therapy or Rehab:

When it comes to physical medicine and rehabilitation therapeutic procedures, there are three commonly used CPT codes. These codes include:

  • CPT code 97110
  • CPT code 97112
  • CPT code 97530

1. CPT Code 97110:

97110 CPT code falls under Physical Medicine and Therapeutic Rehabilitation Procedures. It is a therapeutic procedure; one or more areas, each 15 minutes. According to AMA, this code involves therapeutic exercises for developing the following:

  • Strength
  • Endurance
  • Range of motion
  • Flexibility

CPT code 97110 physical therapy is one of the most common physical therapy CPT codes. Like other therapeutic procedures, CPT code 97110 also requires direct one-on-one contact of the patient with the healthcare physician. However, the coder must review the defined “direct one-on-one contact’s” federal and state guidelines before assigning the CPT code. 

Documentation for CPT Code 97110:

The documentation for CPT code 97110 comes with a couple of requirements. The documentation must include:

  • The body part/(s) being treated; specify the muscles or joints under treatment.
  • List of the specific exercises being performed.
  • Purpose of performing those specific exercises
  • The purpose of each exercise mentioned must be related to the specific functional goal being achieved.
  • The volume of the exercise(s), i.e., no. of sets, type, repetitions, duration of holds, amount of resistance, etc. 
  • How the resistance is determined must also be included in the documentation of CPT code 97110. 
  • The amount of resistance includes weight, torque, and force.

Therapeutic exercises include:

  • Treadmill for endurance
  • Gymnastic ball for stretching
  • Isokinetic exercise for the range of motion
  • For flexibility, lumbar stabilisation exercise
  • And more

Some of the major activities involved in the therapeutic procedure code 97110 include:

  • For the improvement of joint motion: active, active assistive, or passive range of motion
  • To increase the strength of the muscle and endurance; active, resistive exercises
  • Exercise like walking on the treadmill to improve cardio-pulmonary endurance
  • For flexibility, stretches, e.g., ballistic, active, etc.

Commonly used modifiers for 97110 procedure code:

For CPT code 97110, using modifier 52 is inappropriate, as well as reporting this code for less than 8 minutes. If the treatment session is under 8 minutes, don’t bill the service or use modifier 52 to report it. 

When CPT code 97110 is billed under the therapy plan of care for both institutional and professional claims, the following two modifiers are required.

  1. Modifier GO: For the procedures performed under the outpatient occupational therapy plan of care.
  2. Modifier GP: For the procedures performed under the outpatient physical therapy plan of care.

What is the 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 the treatment session to bill one unit. Physicians should use the 8-minute rule when necessary for therapeutic procedures. 

Modifier 59 for CPT Code 97110:

Modifier 59 reports that a procedure is distinct and independent of the other service performed on the same day, i.e., distinct procedural service. This is a level I modifier for CPT code 97110. If/when the 97110 billing code is overlapping with another code from the same category, modifier 59 is used.

2. CPT Code 97112:

CPT code 97112 is maintained by the American Medical Association (AMA). It is another common physical therapy or rehab CPT code. This CPT code also falls under Physical Medicine and Rehabilitation Therapeutic Procedures. 

What is procedure code 97112?

The code description for CPT code 97112 is; therapeutic procedure, one or more areas, every 15 minutes. It involves:

“Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.”

CPT Code 97112 includes the therapeutic procedure that applies to one or more than one body part (multiple parts), similar to therapeutic activity. These procedures require direct one-on-one contact of the patient with the healthcare physician.

Who can code CPT 97112?

Neuromuscular reeducation of movement is a therapeutic procedure performed to restore the body function/movement of the patient. This technique and exercises can include:

– Standing balance exercises

– Seated stability exercises

– Postural reeducation (postural retraining)

– Isometric muscle contractions 

– And more

Does a chiropractor use this CPT code? One of the most common chiropractic procedure codes is 97112.

Documentation for CPT Code 97112:

When it comes to the documentation for medical procedure code 97112, it must be specific and include:

– Specific exercises and activities performed

– The purpose of performing these specific activities and exercises

– Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture.

– Proprioception for sitting and/or standing activities

– Volume of the exercises

– Time spent 

Medical necessity behind the use of CPT code 97112:

The neuromuscular reeducation 97112 procedure code should be reported if the therapeutic procedure is considered medically necessary. The patient’s documentation must include any of the following conditions:

  • Loss of deep tendon reflexes
  • Loss of vibration sense
  • Along with burning, paresthesia, and diffuse pain of the feet, lower legs, and/or fingers.
  • Flaccidity or muscular weakness due to
  • Cerebral dysfunction
  • Nerve injury or disease
  • Spinal cord disease or trauma
  • Nerve palsy 
  • Peroneal nerve injury causing foot drop

CPT Code 97112 for stroke patients:

CPT code 97112 can be applied or used for non-stroke patients as well. They may include muscle diseases and neuromuscular transmission disorders. Except for stroke, CPT code 97112 can also be applied to:

– Motor nerve roots disorders

– Diseases of motor neuron

– Peripheral nerve disorders

 CPT Code 97112 is a time-specific code, i.e., 15 minutes. If the procedure lasts for more than 15 minutes, CPT code 97112 can be reported for each 15 minutes interval. For outpatient orthopaedic rehab settings, this CPT code can play a vital role.

Note that if this therapeutic procedure is performed with more than one individual, then CPT Code 97150 should be reported. Use modifier 59 to report 97112 CPT code with 97110 code, or else the procedures/codes can be bundled. 

3. CPT Code 97530:

CPT code 97530: Therapeutic Activities: requires 

“The use of any dynamic activities that are designed to improve functional performance.”

CPT code 97530 also requires direct one-on-one contact with the patient. Use this code for every 15 minutes of activity. According to AAPC:

“The provider uses various activities during direct contact with the patient to improve the patient’s functional performance.”

CPT code 97530 is commonly used for people having difficulty with the following:

  • Deficits in strength or mobility
  • Loss of coordination or balance
  • Difficulty with sports or certain ADL.

CPT Code 97530 Vs. CPT code 97110:

Deciding and identifying which CPT code (i.e., 97110 or 97530) to report is extremely crucial for correct medical coding. CPT code 97110 is for therapeutic exercises; however, 97530 CPT code is for therapeutic activities. There are two things that should be identified:

  1. Reason behind the choosing the specific code
  2. How many parameters or deficits are being addressed?

Using and billing the correct CPT code is essential for proper medical coding and revenues. Therapeutic activities (CPT 97530) have a higher reimbursement rate than therapeutic exercises (CPT 97110). For this reason, if the intervention is a therapeutic activity, but therapeutic exercises are billed, the healthcare practice is losing revenues.

Therapeutic activity:

A wide range of tasks and activities come under the therapeutic activities CPT code 97530, including the following:

  • Bending
  • Lifting
  • Catching
  • Pulling
  • Pushing
  • Throwing
  • Overhead activities
  • Squatting, etc.

Lifting a heavy object and putting it on the shelf above is an example of therapeutic activity. This activity mainly focuses on strengthening the shoulder.

CPT Code 97530 Coding guidelines and Modifier requirements:

Modifier for CPT Code 97530:

CPT code 97140 of manual therapy is commonly billed alongside CPT code 97530 with modifier 59 to override the CCI edits. According to these guidelines, these procedures can be reported separately only if they were performed in two separate intervals of 15 minutes. Two distinct and separate 15-minute intervals must be clearly indicated in the patient documentation.

Medical Necessity:

A wide range of rehabilitative techniques involving “movement” for therapeutic activities are considered a medical necessity for the patient. Now, these activities can be focused on a specific part or the entire body. Make sure that the activities and their importance with respect to the patient are justified.

Documentation requirements for CPT 97530:

Documentation for the CPT code 97530 must include the following:

– Targeted areas for the improvement

– Assistance levels required 

– Detailed description of the activities performed

– Connection between the activities and their role in restoring the function of daily life must be clarified in the documentation.

Coding Guidelines for CPT Code 97110, 97112 & 97530:

Following are the official guidelines for the commonly used CPT codes for Rehab and physical therapy (e.g., CPT 97110, 97112, & 97530).

1.Speech-language pathologists may perform services coded as CPT codes 92507, 92508, or 92526. They do not perform services coded as CPT codes 97110, 97112, 97150, or 97530, which are generally performed by physical or occupational therapists. Therefore, the Speech-language pathologists shall not report:

2. HCPCS/CPT codes 97110, 97112, 97150, or 97530, as unbundled services.

3. CPT codes (e.g., 97110, 97112, 97530) shall not be reported separately for services related to the canalith repositioning.

4. Physical medicine and rehabilitation services described by CPT codes 97112, 97124, and 97140 are not separately reportable when performed in a spinal region undergoing CMT.

Conclusion:

Using the correct code for physical therapy or Rehab is extremely crucial for proper medical billing and revenues. Several outsourced medical billing services companies offer reliable and complete medical billing solutions. Outsourcing medical billing comes with various benefits for the healthcare practice. UControl Billing is a result-oriented and well-reputed medical billing outsourced services company. We offer competitive and affordable pricing, uninterrupted service, and stability.

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Frequently Asked Questions (FAQs)

1. What is procedure code 97112 in medical billing?

CPT code 97112 is one of the common physical therapy or rehab CPT codes. The code description for CPT code 97112 is a therapeutic procedure, one or more areas, every 15 minutes. It involves:

“Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.”

2. What are common procedure code 97112 errors?

There are several errors when it comes to medical coding. Most common coding errors include the use of incorrect code, wrong modifier, and incomplete or inaccurate documentation. These errors result in the claim denials and rejections, affecting the healthcare practice’s reimbursements and revenues.

3. How do you prevent procedure code 97112 errors?

Using the correct code and modifier is essential for proper medical coding. The documentation for medical procedure code 97112 must be specific and include:

  • Specific exercises and activities performed
  • The purpose of performing these specific activities and exercises
  • Volume of the exercises
  • Time spent

References:

https://www.codingahead.com/cpt-code-97112-description-guidelines-reimbursement/

https://www.codingahead.com/97110-cpt-code-description-reimbursement-modifiers-guidelines/

https://www.codingahead.com/cpt-code-97530-description-guidelines-reimbursement-modifier/

 

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