Let’s face it…billing is by far one of the toughest and potentially confusing parts of our jobs as therapists. Choosing the appropriate CPT code to bill to ensure your clinic receives the correct reimbursement from insurance, can be extremely stressful and time consuming, especially if you aren’t sure of the difference between the codes, specifically therapeutic exercise (97110) and therapeutic activity (97530).
While therapeutic exercise (97110) and therapeutic activity (97530) are often confused due to sharing common goals and what the patient is working towards with them, each code is unique in its own way, and therefore should be billed appropriately. If you struggle with deciding whether you should bill CPT code 97110 or 97530, here is a quick overview of the differences:
CPT Code 97110- Therapeutic Exercise
What is it?
Therapeutic exercises are movements that are typically performed to prevent loss of range of motion, maintain or improve muscular strength or increase flexibility, following either an injury or surgery.
When billing and documenting for therapeutic exercise, the following must be kept in mind. You must include the body part(s) treated, and should include specific muscle(s) and/or joint(s) to avoid any confusion about each exercise. The following are some examples of different exercises that should be billed under CPT code 97110:
- Active, active-assisted, or passive range of motion for increased ROM of a specific joint
- Resistance exercises for improved muscular strength, including isometric, isotonic, and isokinetic
- Exercises to improve aerobic or cardiopulmonary endurance, including: treadmill, bicycle, or NuStep
- Any active stretches which are being utilized to improve flexibility.
Therapeutic exercises typically target single parameters, such as improving ROM or increasing strength so make sure you explain the purpose of each exercise and how it relates to a specific functional goal in your documentation. Therapeutic exercises often contribute to an improved ability to perform real-life movements, such as ADLs, work related tasks and sports activities. However, when working directly on improving real-life movements, then it falls under CPT code 97530 (see below), and should be billed as such.
CPT Code 97530- Therapeutic Activities
What is it?
According to Optum 360° and the APTA, therapeutic activities require the “use of dynamic activities to improve functional performance.”
When considering whether the activity you are having the patient perform is classified as a therapeutic activity or if it falls under a different category, here are some questions to ask yourself:
- Is this a functional activity, such as climbing stairs?
- Will this improve his/her functional performance, in daily life, at work, or in a sport?
- Is more than one parameter (strength, coordination, etc.) being addressed with this activity?
- Does this activity directly correspond or relate to a specific work or sports task that the patient will be performing once they have fully recovered?
If you answered yes to any of the above questions, then you would bill 97530 for therapeutic activities. Therapeutic activities cover a wide range of functional activities, such as squatting, ascending/descending stairs, walking, bending, lifting, catching, throwing, pushing, pulling, etc. It is important to note that Medicaid plans only pay for 97530 codes and do not pay for 97110 therefore it should always be verified prior to seeing a patient
Therapeutic activities also tend to incorporate the use of multiple parameters (balance, coordination, power, strength, range of motion, etc.) into one activity/exercise. When documenting, be sure to document the specific relationship to a functional activity and how it applies to that particular patient. An example of this would be: lifting a weight overhead and placing it on a shelf which not only improves shoulder strength, but plays a huge role in your patient being able to reach an overhead cabinet without pain or discomfort.
When deciding whether or not you should bill CPT code 97110 for therapeutic exercise or 97530 for therapeutic activities, first decide your intention for choosing that specific intervention and whether or not it addresses one parameter or multiple parameters. It is extremely important that you accurately identify and bill the correct code as the code for therapeutic activities has a higher reimbursement rate than therapeutic exercise. If you are billing everything under therapeutic exercise, when the intervention is actually a therapeutic activity, then you are losing out on money for your clinic.
Proper documentation and differentiation of therapeutic exercise and therapeutic activities can take a while to grasp so be sure to follow the above tips and tricks to help avoid confusion! HelloNote allows you to document quickly and even adds a modifier automatically to ensure the reimbursement is rendered! You can sign up for a free demonstration here to see exactly how easy it is to use the HelloNote software here: https://hellonote.com/
References
http://news.meyerdc.com/chiropractors/build-your-practice/difference-cpt-codes-97110-97530/