The following information about 97110 is pulled straight from page 288 in the 2016 ChiroCode DeskBook. It is one of twenty CPT codes in Chapter 5.2, Common Procedure Codes. Each code gets a thorough, but concise, review in this newly expanded chapter. First, the code is explained, then important tips are listed. And finally, each code is given a list of suggested diagnoses and modifiers, as appropriate. More general tips about documentation for Physical Medicine and Rehabilitation codes also appear on pages 283 and 284 as well. This information was gleaned from various sources, including our very own HelpDesk, Medicare LCDs, and the AMA CPT Assistant newsletter, but remember that different rules may apply for different payers. See the 2016 DeskBook for help with more codes.
97110 THERAPEUTIC EXERCISES, EACH 15 MINUTES, ONE OR MORE AREAS
Therapeutic exercise incorporates one parameter (strength, endurance, and 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 exercise (for flexibility), and gymnastic ball (for stretching and strengthening).
- This code requires direct one-on-one contact with the provider. The number of regions is irrelevant when billing units of time with this procedure code.
- Review both state and federal guidelines defining “one-on-one patient contact” before choosing this code. Usually the provider or a trained individual must remain with the patient in order to monitor patient safety and ensure that the procedure is done correctly. Some states allow this service to be delegated to a trained individual to monitor and assist the patient.
- Documentation should explain why a skilled provider is necessary and include goals which focus on improvement of functional deficiencies.
- If there are more than 12-18 visits or 4-6 weeks of treatments, payers may be likely to review documentation for evidence of medical necessity. If the exercises are passive, 2-4 visits may be all that is covered by a payer.
- Per CPT guidelines, “A minimum of eight minutes of therapeutic exercises is required to report code 97110. Services of less than eight minutes would not be reported.” This means that this code cannot be reported with modifier 52 (reduced services) if less than eight minutes was performed.
- 97110 should not be billed for exercises to promote overall fitness, flexibility, endurance enhancing, aerobic conditioning, and weight reduction. However, it may be billed for maintenance of ROM or strength if the presence of a skilled therapist is needed.
Loss or restriction of joint motion, strength, flexibility, functional capacity, or mobility from a specific disease or injury.
Consider ICD-10 codes from the following groups:
M47 M48 M50 M51 M53 M54 M62 M99 S13 S16 S23 S29 S33 S36 S39