With so many procedural codes and their specific reimbursement guidelines, medical coding is hard to follow. Thus, we thought of extending a helping hand to healthcare providers struggling to manage their practice’s financial activities while providing quality patient care. How? By starting a series of blogs to educate practitioners on different codes.
This guide is a part of that series! It discusses neuromuscular reeducation, CPT code 97112’s description, applicable scenarios, and reimbursement guidelines.
So, without further delay, let’s dive into the details!
Understanding Neuromuscular Reeducation
It is based on the principle of neuroplasticity and focuses on facilitating optimal muscle activation, improving neuromuscular control, and correcting faulty movement. Here’s a list of its main goals:
- Coordination and balance enhancement
- Muscle function restoration
- Alignment and posture improvement
- Motor control refinement
Besides, it involves performing specific activities and exercises to enhance motor function and the form of new neural pathways. Below is the list of techniques and methods used in neuromuscular reeducation:
- Balance training
- Therapeutic exercises
- Gait training
- Proprioceptive training
- Neuromuscular electrical stimulation (NMES)
For the unversed, neuroplasticity is the brain’s ability to adapt and reorganize to new stimuli.
CPT Code 97112 – Description
The 97112 CPT code comes under the range of ‘Physical Medicine and Rehabilitation Therapeutic Procedures’ as maintained by the American Medical Association (AMA).
It is a neuromuscular reeducation CPT code used to report treatment performed by a physician, aiming to improve kinesthetic sense, coordination, posture, motor control, and proprioception using therapeutic intervention.
Only qualified providers, such as occupational therapists (OT), physical therapists (PT), or physicians, are allowed to perform the reeducation treatment.
Scenarios Where CPT Code 97112 is Applicable
Below are some scenarios where providers may use the CPT code for neuromuscular reeducation.
For Post Stroke Recovery
Consider a patient who had a stroke recently. The PT decided to use techniques like proprioceptive neuromuscular facilitation (PNF) to help the patient regain motor function and balance.
As a result, the therapist employs complex neuromuscular reeducation for retraining muscle patterns, focusing on activities such as reaching, walking, and standing. Thus, the PT will report CPT code 97112 to bill the services rendered.
For Parkinson’s Disease Management
Another scenario where you can apply neuromuscular reeducation CPT code is when the PT opts for techniques such as Lee Silverman Voice Treatment (LSVT) to help a patient with Parkinson’s disease enhance balance, gait, and motor control while involving exercises to reduce tremor impact and improve coordination for daily activities.
For Spinal Cord Injury Recovery
When a patient encounters a spinal cord injury, the therapist often instructs weight-bearing exercises and activities like mobility and balance training. Since the improvement in balance, coordination, and strength is achieved through neuromuscular reeducation, PTs can report these services with the 97112 CPT code.
Common Misconceptions Associated with 97112
Many healthcare providers may confuse the 97112 CPT code with therapeutic exercise codes, such as 97110. However, both codes have different scopes. CPT code 97110 indicates general physical conditioning, while CPT code 97112 focuses specifically on neuromuscular reeducation via skilled interventions.
97112 CPT Code Reimbursement Guidelines
Several compliance risks are associated with reporting the 97112 CPT code, such as inadequate supervision during the intervention, sharing treatment time with other patients, or providing the treatment through a non-qualified professional.
If you are a physical therapist troubled by the many compliance risks that may jeopardize your reputation, we recommend outsourcing the physical therapy billing services to professionals like MediBill MD.
However, by following the reimbursement guidelines stated below, you can bypass compliance risks and ensure timely payment against CPT code 97112.
Patient Assessment
You should start by evaluating the neuromuscular impairments, including proprioception, coordination, or balance issues. Thoroughly document all findings and identify goals to improve the patient’s motor function.
Establish Medical Necessity
The next step to ensure accurate reimbursement for CPT code 97112 is to determine the medical necessity for neuromuscular reeducation based on your findings in the previous step. The diagnosis may include conditions like post-surgical recovery, brain injury, stroke, or Parkinson’s disease.
Intervention Selection
Now comes the selection of appropriate intervention covered under this neuromuscular reeducation CPT code. It could be proprioceptive exercises, coordination training, or balance reeducation, tailored specifically to treat the patient’s condition and help them perform their daily chores more efficiently. However, you must ensure that your proposed therapeutic intervention aligns with the treatment plan.
Planning and Documentation
You should follow Medicare’s 8-minute rule and divide the neuromuscular reeducation treatment time into 15-minute increments. That is, each unit must include at least 8 minutes of one-on-one skilled therapy by a qualified provider.
Also, remember to document the treatment’s start and end times to ensure you receive the right reimbursements for your performed activities with the 97112 CPT code.
Monitor and Adjust
Since the treatment is tailored, you should proactively monitor the patient’s progress and adjust the proposed interventions accordingly for the best results.
Comprehensive documentation is key to getting timely payments. Thus, try to record any updates in the treatment plan, outcome, and patient feedback.
Summary
Here’s a quick recap of what we learned in this guide related to the CPT code 97112. We discussed neuromuscular reeducation, scenarios where you can report code 97112, common misconceptions related to it, compliance risks, and reimbursement guidelines.
We covered all aspects thoroughly to deepen your knowledge about this code. However, if you still have questions and queries, connect with our medical billing representative. We offer tailored medical billing services to more than 50 specialties nationwide at affordable rates.
Frequently Asked Questions
