Physical therapy and occupational therapy aim at improving people’s ability to perform daily activities. While occupational therapists specialize in conditions affecting the elbow, wrist and hand, physical therapists treat spine conditions and other body parts including the foot, ankle, knee, hip and shoulder. There are specific CPT codes to report physical therapy and occupational therapy procedures in claims. Professional physical therapy billing services are available to help providers accurately report various therapeutic procedures and activities and ensure appropriate and timely reimbusement.
Most of the CPT codes that are relevant to rehab therapists fall in the 97000 section (“Physical Medicine and Rehabilitation”). Let us discuss three common CPT codes for physical therapy and occupational therapy and documentation tips.
- CPT 97110: Therapeutic Procedure
- CPT 97112: Therapeutic Procedure (stroke and non-stroke) and
- CPT 97530: Therapeutic Activities
CPT 97110: Therapeutic Exercise
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
Therapeutic exercises are specially designed exercises and activities to help patients gain better mobility and fitness levels. CPT code 97110 describes foundational occupational therapy exercises that help improve a patient’s strength and range of motion. Therapeutic exercises include treadmill for endurance, gymnastic ball for stretching, isokinetic exercise for range of motion, lumbar stabilization exercise for flexibility and more. For proper reimbursement, it is important for the documentation to include the area of the body focused on and the type, quantity, and purpose of exercises performed during occupational therapy sessions.
To report CPT 97110, a minimum of eight minutes of therapeutic exercises needs to be performed. Do not report this code for less eight minutes. It is also not appropriate to append modifier 52 (reduced services) with this code. The documentation must include the body part/s treated, specifying the muscles and joints. Also explain the purpose of each exercise as related to achieving a specific functional goal. This code requires direct one-on-one contact with the provider and before assigning it, coders must review both state and federal guidelines that define “one-on-one patient contact”
CPT 97112: Therapeutic Procedure
Therapeutic Procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.
Physical therapists use neuromuscular re-education technique to help patients restore normal body movement patterns. Exercises that are considered as neuromuscular re-education include standing balance, seated stability exercises, postural re-training, isometric muscle contractions and more. It includes BAP’S Boards, Proprioceptive Neuromuscular Facilitation (PNF), Feldenkreis, Bobath and more.
It is important for the documentation to include specific exercises or activities performed and the purpose. Also provide information regarding volume of exercise, time duration, and specific techniques used. The coder may have to add modifier 59 to 97112 to inform that is a different 15-minute time period than the 97110, otherwise the codes will be bundled.
Some payers accept CPT 97112 for stroke patients as well as others such as neuromuscular transmission disorders, and muscle diseases. Outpatient orthopedic rehab settings can also report procedures using this code. This procedure also requires direct one- on -one patient contact by a physician or therapist. If this procedure lasts more than 15 minutes, the CPT code can be reported for each 15-minute interval.
Another key point to note is that if this neuromuscular re-education procedure is performed with two or more individuals, then coders have to report code 97150. Make sure not to code the specific type of therapy in addition to the group therapy code.
CPT 97530 Therapeutic Activities
Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes.
CPT code 97530 covers a broad range of rehabilitative techniques such as bending, lifting, carrying, reaching, catching, transfers and overhead activities to improve mobility, strength, balance, coordination and functional performance.
It is important that the documentation includes the targeted areas for improvement and assistance levels required as well as a detailed description of these activities. Documentation must make a clear connection between the activity and its role in restoring a function of daily life.
This code describes a therapy session that addresses multiple deficits through participation in a functional activity. To use this code, it is necessary for the provider to be present with the patient for the entire session, in an active, active-assisted, or passive role.
The major difference between CPT 97110 and 97530 is the number of target areas being addressed during the activity. 97530 CPT code most frequently focuses on two or more areas. CENTURY REHAB provides this example: “while the patient sitting in the wheelchair and using 2# ankle weights can be billed under 97110, the patient using 1# cuff weights while participating in a fine motor task at table top can be best billed under 97530”.
Reliable medical billing and coding companies provide the services of coders who are knowledgeable about using the correct CPT codes to report therapeutic procedures, helping practitioners submit accurate claims and avoid denials.