There are many things to consider when determining whether active-care rehab is a service you would like to provide for your patients.
Among them, and perhaps most importantly, is how to describe the various services with the correct coding. Most exercise options available in a typical chiropractic rehab room will fit into three categories: Therapeutic exercises, coded 97110; Therapeutic activities, coded 97530; and Neuromuscular reeducation, coded 97112. Each has specifics that must be considered when selecting the appropriate code that best describes the context.
These service codes fall in the CPT category of therapeutic procedures. These procedures are usually coded and billed based on the intended outcome instead of the device or equipment used. You must document the intended outcome, how the procedure is performed, and how the patient is progressing with their care plan using the exercises prescribed by the doctor.
The patient’s treatment plan should indicate a direct functional goal or outcome that results from performing this service. For example: “The patient will be able to ambulate 300 feet with minor discomfort, and without an assistive device or rest period.”
In the treatment plan, detail the intended outcome with the equipment used (e.g., treadmill for endurance, balance ball for flexibility, wobble board for stability, or isokinetic exercises for range of motion). Standard treatment for these procedures could be 12 to 18 visits within a four- to six-week period. If these activities are performed with multiple patients at once, use code 97150 for group exercise. When billing these procedure codes, keep in mind they are timed codes.
You must document the time spent performing the service. If the exercise service is performed for less than eight minutes, as required by these codes, you may not bill for it.
97110: Therapeutic exercise
CPT code 97110, therapeutic exercise, is a therapeutic procedure that treats one or more areas. The exercises are used in patient care to develop a single-exercise parameter that includes strength, endurance, range of motion, and flexibility. These activities are performed one-on-one with the patient. This code is for a distinctly separate and unrelated procedure and is not considered inclusive of the CMT codes 98940–98943.
The activities involved, as described by this code, may include free weights, treadmill, balance balls, wobble boards, stretching, range of motion, isometric exercises, and others. Code 97110 is usually considered medically necessary for loss or restriction of joint motion, strength, functional capacity, or mobility that has resulted from disease or injury.
Each third-party payer may define medical necessity; therefore, be aware of the payer’s definitions before billing on behalf of the patient.
If only one outcome or parameter is intended by the exercise, CPT code 97110 is used. If one or more parameters are addressed (such as balance and strength, range of motion and flexibility), and there is one-on-one contact with the patient, CPT code 97530 is used. Noting the specific functional goal or activities of daily living (ADL) that you intend to improve helps substantiate the use of 97530.
97530: Therapeutic activities
The code for therapeutic activities is used when multiple parameters are trained—including balance, strength, and range of motion. The provider must include goals that are specifically related to a functional deficit in the treatment plan if improvement is expected, based on the patient’s chief complaint and exam findings. Functional deficits, as well as the improvements, can be reported through any measurable outcome assessment tools (OATs).
When procedures involve functional activities (e.g., bending, lifting, carrying, reaching, pushing, pulling, stooping, catching, and overhead activities) to improve performance in a progressive manner, this code is appropriate. The activities are usually directed at a loss or restriction of mobility, strength, balance, or coordination in the patient, based on the measure reported by an updated OAT. This code requires the professional skills of a provider; it is designed to address a specific functional need for the patient, as indicated in the initial documentation and OATs.
A provider may decide therapeutic activities are appropriate after a patient has completed exercises focused on strengthening and range of motion, but still exhibits a need to progress to a more function-based activities therapy to improve functional goals. Dynamic activities directed at a specific outcome must be part of an active treatment plan and documented in the patient’s notes.
97112: Coding neuromuscular reeducation
The proper reporting of neuromuscular reeducation (NMR) is one of the more significant coding dilemmas chiropractors face. This is in part because there are so many defini- tions of NMR and ways they are interpreted.
Although NMR seems to have no universally accepted definition, it generally refers to a treatment, technique, or exercise performed by an individual with the purpose of improving communication between the body and the brain via the nervous system. Part of the NMR process during this phase are activities referred to as proprioceptive training.
Proprioception is the awareness of the position of one’s body or the sensing of the relative position of neighboring parts of the body. The proprioceptive system provides feed- back solely on the internal status of the body. It is the sense that indicates whether the body is moving with required effort and where the various parts of the body are in relation to one another.
There are excellent clinical indications for a chiropractor to provide proprioceptive training. This raises the bigger question of how to report that you’re doing this type of work and if it should be coded 97112.
The American Medical Association defines NMR as follows: “97112: Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities.”
In describing the services that can be included under this code, the AMA clarified that “Some common examples of this service include Proprioceptive Neuromuscular Facilitation (PNF), Feldenkrais therapy, Bobath treatment, BAPS boards and desensitization tech- niques.” Given that this code is a therapeutic procedure, it requires complete one-on-one attendance during the therapy. Depending on your state’s rule, that could mean with the doctor or a qualified and properly trained team member.
Because the description of this code includes PNF stretching, it is often billed in chiropractic offices as muscle work performed by the doctor or a massage therapist. The AMA has stated that the description of the service is more specific. From a CPT coding perspective, code 97112 is intended to identify NMR.
It was designed to reeducate the muscle for some function it was previously able to do, but it was not intended to identify massage to increase circulation, or a non-NMR purpose. For this reason, you are strongly advised against using 97112 for muscle-related work within the confines of a chiropractic treatment plan. There are other codes better suited to describe this type of work.
Doctors who practice certain techniques may use a wobble chair or a vibration plate. They describe the work as NMR and code it 97112. Because most patients use the wobble chair or vibration plate without direct one-on-one attendance and without proper documentation of why these services are being provided, using code 97112 is problematic.
From an insurance billing perspective, using code 97112 requires a significant amount of medical necessity and the ability to meet the medical review policy of the carrier (e.g., Aetna has a highly specific medical review policy concerning the use of 97112).
Active care rehab is an excellent service provided by chiropractic practices. Careful attention to coding, documentation, and description of the work performed is critical to keep you compliant and confident.
Kathy Mills Chang is a certified medical compliance specialist (MCS-P), a certified chiropractic professional coder (CCPC), and a certified clinical chiropractic assistant (CCCA). Since 1983, she has provided chiropractors with reimbursement and compliance training, advice, and tools to increase revenue and reduce risk. She leads a team of more than 25 at KMC University and is one of the profession’s foremost experts on Medicare, documentation, and compliance. She can be contacted at 855-832-6562 or firstname.lastname@example.org.