When billing 3rd 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, and some seem similar and overlap. Yet insurance companies do not think so when processing your claims. In this blog, I’ll show you how to differentiate between them with proper coding.
Exercise Billing: 97110, 97112, or 97530?
Let’s take a deeper look into the proper CPT® coding for exercise therapies. These codes are similar, and it is important to understand how the context and documentation define the differences between them. The details of these codes are dependent on the documentation of each, so providers must recognize the distinctions between these codes as they relate to the intent behind the prescription of the exercise.
These are procedure codes, not modality codes. This means that 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 the encounter itself requires direct one-on-one contact with the person providing the service. Provider documentation should include the total time spent with the patient during the provision of the service and a description of the specific exercise procedure 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 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. Therapeutic Exercises are usually considered medically necessary for loss or restriction of joint motion, strength, functional ability, or mobility that resulted from disease or injury. The standard treatment protocol is 12 to 18 visits within a four- to six-week period.
97112: Neuromuscular Re-education
This therapeutic procedure is used to provide improved balance, coordination, kinesthetic sense, posture, and proprioception to a person who is 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.
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. You 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 involves using functional activities (e.g., bending, lifting, carrying, reaching, pushing, pulling, stooping, catching, and overhead activities) to improve functional performance progressively. The 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 need. It may be appropriate, once a patient has completed therapeutic exercises focused on strengthening and range of motion, to then 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.
Low-Tech Rehab Supports Optimal Treatment Results
High-tech equipment, like exercise machines, is not always necessary to be able to offer in-house services to patients. They tend to take up a lot of floor space and often require more skilled personnel to supervise and instruct patients in their use. Low-tech rehab, like the use of bands, balls, and body-weight exercises, is an excellent way to offer these services in an effective, space-saving manner. 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 that requires minimal technical understanding lets the patient get more involved in their treatment making them more likely to perform their at-home exercises and take part in their healing process.
Foot Levelers NECKSYS Neck System, for example, is a key component of comprehensive cervical spine rehabilitation. It 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 a patient 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.
The Foot Levelers TRI-FLEX is a wall-mountable total body rehab system. This opens more possibilities of 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, as well as 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. This low-tech system is an easy decision for practices that want to begin offering these important rehab services, but want an affordable, space-saving option. Components of the in-office TRI-FLEX, like the THERA-CISER, can be sold to the patient for home use with provider instructions.
Visit the Foot Levelers Rehabilitation Website for additional FREE doctor-reviewed rehabilitation resources, such as instructional videos, informational articles, tips, custom orthotic recommendations for more effective rehabilitation and chiropractic care, and more. Whether you are establishing rehabilitation protocol or expanding your existing options, you’ll find a wealth of tools to help elevate your care.
Get Hands-On Rehab Training While Earning CEs
In many cases, CPT® codes to describe spinal rehab in the office carry a third-party value greater than the spinal adjustments. This leads to providers diving into offering services that they haven’t been properly trained to do. Fortunately, Foot Levelers offers excellent rehab-focused CE Seminars throughout the country, with hands-on training for providers and team members interested in adding this service to their practice. Learn how documentation must drive coding. Learn how affordable low-tech rehab in the practice can be. It’s a win-win situation for your patients: supporting their recovery process and complementing ongoing chiropractic care while adding valuable service offerings to your practice.
Kathy is a globally recognized expert on the compliance and financial operations of a successful chiropractic practice. With 40 years of service to the chiropractic community, she got her start as a CA in 1983. Since then, Kathy has been sharing her expertise on Medicare, compliance, billing, coding, insurance, patient financial procedures and documentation with audiences around the world. A popular and highly experienced speaker, she has served on many national and state level chiropractic organizations, boards and advisory councils. She is also the owner and CEO of KMC University, which she founded in 2007.
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