Medical code selection requires keen attention as it must accurately and precisely define the rendered procedure for fair reimbursements. If the available codes fail to describe a specific procedure completely, then there are various modifiers to assist coders. But, overusing modifiers can also backfire and may lead to audits. All these intricacies keep healthcare providers on their toes.
This guide will free you from some of the stress by explaining everything you need to know about the CPT code 97110. So, without further ado, let’s get started!
97110 CPT Code – Description
The CPT code 97110 is a timed code that requires 15 minutes of direct physician contact with the patient, providing guidance, or performing therapeutic exercises. It is a type of physical therapy that involves specially tailored activities and exercises to help patients achieve improved fitness levels and enhanced mobility.
Therapists may perform these exercises either to help patients with injury-related disabilities or post-surgical recovery, provide relief in osteoporosis, and enhance overall health during pregnancy. Under this CPT code, workout programs are specifically designed based on individual patient needs and may involve breathing and physical exercises.
Scenarios Where CPT Code 97110 is Applicable
Discussed below are some practical scenarios where CPT code 97110 may apply:
Prenatal and Postpartum Fitness
Assume a pregnant woman receiving therapeutic exercises to improve pelvic floor stability and core strength and prepare for labor and delivery. Thus, the therapist guided her through various exercises, including prenatal yoga to enhance breathing, balance, and flexibility, a walking regime to improve endurance and cardiovascular fitness, and a kegel workout to strengthen pelvic floor muscles.
Thus, the therapist will report CPT code 97110 to ensure rightful reimbursements against the therapeutic exercise guidance.
Post-Surgical Recovery
Consider a patient who recently underwent knee replacement surgery and visited a therapist to strengthen the quadriceps and hamstring muscles and improve motion range and gait stability.
As a result, the therapist guided the patient through an active range-of-motion workout for flexing and extending the knee, balance exercises such as standing and walking with a gait, and strengthening exercises such as squats (with/without assistance) and leg lifts. Here, CPT code 97110 will apply.
Neurological Rehabilitation
Let’s assume a scenario where a patient is recovering from a stroke and encounters a therapist for therapeutic exercises to improve functional mobility, coordination, and balance.
As a result, the therapist guided the patient in functional mobility conditioning, such as walking with a cane, transferring from bed to chair, etc., balance exercises, such as tandem walking (heel-to-toe) and standing on one leg, and coordination enhancement activities, such as catching a ball and reaching for objects.
Thus, CPT code 97110 will apply to ensure the therapist receives accurate payment for the therapeutic exercises.
Things to Consider While Billing CPT Code 97110
Here are some factors to consider before billing this CPT code:
Effective Time Tracking
Since CPT code 97110 is a time-based code, you must ensure accurate time tracking and recording to receive the rightful reimbursement against the rendered therapeutic exercises. Besides, note that the Medicare 8-minute rule is applicable. That is, healthcare providers must spend at least 8 minutes providing direct face-to-face time with the patient to bill one unit of this CPT code.
Also, remember that you cannot bill the time you spend on documentation or tailoring the therapeutic exercise regime for the patient. Record and bill only the time that you spend directly helping the patient perform the exercises.
Ensure Detailed Documentation
Comprehensive documentation is critical when billing the CPT code 97110. This documentation must clearly state the deficit area/body part, making it challenging for the patient to lead a quality life and perform routine activities efficiently.
Do not forget to include details related to how you designed an exercise routine to improve the patient’s condition and mention the type, quantity, and purpose of these workouts during the session.
Therapeutic exercises are typically tailored to target specific parameters, e.g., improving strength, enhancing range of motion (ROM), etc. Thus, you should also explain how each exercise will target a specific area. All these details will help establish the medical necessity and appropriateness of the rendered exercises, leading to timely reimbursements for CPT code 97110.
Moreover, as the treatment progresses, you should cover how the proposed exercises have facilitated the treatment of deficit body parts, such as joints, muscles, etc., and what treatment updates were made.
Using Modifier 59
When reporting the CPT code 97110, appending modifier 59 is essential to indicate the therapeutic exercise service was independent or distinct from other rendered procedures on the same service day. However, remember that adding modifier 59 is only appropriate when you are billing this CPT code with any of its pairs for the same service date in distinctly separate 15-minute intervals.
Understanding Specific Payer Guidelines
Payer reimbursement guidelines and billing requirements vary. That is, there cannot be a standardized approach to ensuring clean claim submission when you are dealing with mixed payers (Medicare, Medicaid, and other commercial payers). Thus, we recommend establishing clear lines of communication with insurance payers to understand their specific guidelines when it comes to billing CPT code 97110 or any other physical therapy code.
Summary
Let’s quickly recap what we learned! We discussed a detailed explanation of the CPT code 97110 and reviewed some practical scenarios where it is applicable. These include post-surgery recovery, prenatal and postpartum fitness, and neurological rehabilitation.
Besides, we shared what factors you should consider while reporting this code, including adequate documentation to establish medical necessity and appropriateness of rendered services, time tracking, use of modifier 59, and review of specific payer guidelines.
Do all these details make you overwhelmed? Don’t worry because, at MediBillMD, we have highly skilled billing specialists and certified professional coders (CPCs) to provide physical therapy billing services and help you streamline your billing workflow for ultimate financial success.
