Question: “Dr. Kotlar, I’m not sure how to differentiate between CPT codes 97110 and 97530. They seem very similar to me. Can you explain the difference and provide some practical examples?”
Answer: CPT code 97110 is a therapeutic procedure, on one or more areas, each lasting 15 minutes. Therapeutic exercises are performed in either an active, active-assisted or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening) approach. The exercises may be reasonable and medically necessary for a loss or restriction of joint motion, strength, functional capacity or mobility that has resulted from a specific disease or injury.
Documentation must show objective loss of joint motion, strength or mobility (e.g., degrees of motion, strength grades, levels of assistance). Therapeutic exercise includes activities related to strengthening, endurance training, range of motion, and flexibility. These activities can include use of free weights, exercise machines such as treadmills and range of motion exercises (passive and active). Therapeutic exercises describe services aimed at improving a parameter, such as strength, range of motion, etc.
CPT code 97530 is therapeutic activities, direct (one on one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes. This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, catching and overhead activities) to improve functional performance in a progressive manner. The activities are usually directed at a loss or restriction of mobility, strength, balance or coordination. They require the professional skills of a provider and are designed to address a specific functional need of the patient.
These dynamic activities must be part of an active treatment plan and directed at a specific outcome. Therapeutic activities can be thought of as the “ing” code – dynamic activities that work towards functional performance such as lifting, bending, pushing, pulling, jumping and reaching would be billed as 97530.
Documentation of Therapeutic Procedures:
Modalities (e.g., mechanical traction, ultrasound) are generally coded and billed based on the device that is used. Therapeutic procedures are generally coded and billed on the basis of the intended outcome, not on a device or piece of equipment. When billing and coding for therapeutic procedures, it is very important to document the intended clinical outcome as well as how the procedure is performed.
Therapeutic exercise incorporates one parameter (strength, endurance, range of motion or flexibility) to one or more areas of the body. Examples include, treadmill (for endurance), isokinetic exercise (for range of motion), lumbar stabilization exercises (for flexibility), and gymnastic ball (for stretching or strengthening).
Therapeutic activities incorporate the use of multiple parameters, such as balance, strength, and range of motion, for a functional activity. Examples include lifting stations, closed kinetic chain activity, hand assembly activity, transfers (chair to bed, lying to sitting, etc), and throwing, catching, or swinging.
The relationship to a functional activity is important to document in the treatment plan. An example might be to increase flexibility of the quadratus lumborum muscles while activating and strengthening the hamstring muscles to improve the patient’s capacity for walking and standing.
You should determine how many outcomes are expected by the particular procedures being performed. If only one outcome is intended by the exercise, CPT code 97110 should be used.
Where more than one outcome is expected using balance boards, fitness balls, stretch bands, etc. where increased motion, flexibility, strength and/or improved proprioception is intended, CPT code 97530 should be used.
Therapeutic exercises and therapeutic activities should be clearly described in your initial treatment plan: send an email if you’d like to receive a sample chiropractic treatment plan.
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