How to Select the Right Exercise CPT Code for your Therapeutic Procedure Services

If you’ve read coding blogs on my site in the past, you have likely already read that the best coding policy is to select the code that best fits the service rendered.

One of the most confusing coding choices in most Chiropractic offices we’ve spoken with is selecting which therapeutic procedure to use on a claim.

Exercise codes especially tend to be confusing for many providers since the actual exercises may be very similar for each specific code!

Here is what is recommended for the commonly used exercise related goals/codes:

1. Evaluate what the goals are

  1. Develop strength, endurance, ROM, and flexibility (CPT code 97110)
  2. Re-train a body part to perform a (usually simple) function it used to be able to do in its pre-injury state (CPT code 97112)
  3. Improve functional performance (CPT code 97530)
  4. Re-training related to performing regular day-to-day activities/ADL (CPT Code 97535)
  5. Re-training the body to walk or go up/down stairs with normal gait patterns (CPT Code 97116)

2. Are these activities performed with more than 1 patient at once?

  1. Yes – use 97150 instead
  2. No, provider is spending one-on-one time with the patient – use suggested code above

3. Calculate the units properly (refer to earlier blog post http://toddcrabtree.com/documenting-timed-therapy-codes/)

4. Choose modifiers appropriately

  1. 59 modifier indicates the procedure was separate and distinct from the primary procedure (in most cases for Chiropractic visits, this is the manipulation), it is useful to use on the following exercise codes discussed when billed in conjunction with a CMT:
    1. 97112
    2. 97530
    3. 97353

5. Document for medical necessity in your Chiropractic EHR notes

  1. Refer to the goals in the first section – document to prove what you are doing is accomplishing the goals
    1. Service performed/CPT code/anatomical region/diagnoses
    2. Time Duration for each service
    3. Goals (short term and long term)
    4. Treatment parameters/exercise description/frequency
  2. Choose diagnoses wisely – your patients’ conditions aren’t all the same – don’t code them all the same!
    1. Diagnosis must be based on exam findings
    2. Diagnoses should be specific to the patient’s condition – especially if a functional deficit is being treated
    3. Select diagnoses that accurately reflect why the patient needs your care that also helps support your treatment duration
    4. Use your claim diagnosis pointers to show what specifically is being treated – especially if conditions/regions are different than what is being treated by other services that date

6. Check with your Chiropractic billing software to ensure you are able to point separate diagnosis codes to different services to maximize your reimbursement on each service performed.

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About the author

Todd Crabtree

Todd Crabtree

Founder & Chief Technology Officer. Founded Clinic Doctor Inc. in 2004, to innovate the providing of insurance billing services to healthcare providers in chiropractic clinics that lacked the resources to pay for qualified billing professionals.

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