CPT code 97110
Current Procedural Terminology (CPT) code 97110 is a Therapy Procedure using exercise to increase or maintain strength, endurance, flexibility, or range of motion to one or more areas of the body. This code is important for occupational therapists who aim to use foundational exercises when helping someone experiencing a physical impairment be more independent in their daily routine.
This article will cover the basics of billing for this code during sessions. This information is intended for basic guidance and does not serve as clinical advice for coding. Official information for CPT® codes can be found on the American Medical Association’s (AMA) website where you can find the Current Procedural Terminology manual (“CPT® Manual”) and other valuable resources to help you better understand these codes.
Understanding CPT code 97110
The American Medical Association describes CPT code 97110 as a therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, every 15 minutes. This is a timed code, meaning one unit is billed per 15 minutes of direct, one-on-one contact with the patient, respecting the eight-minute rule per payer requirements.
Specific procedures within this code include motions that require repetitions targeting physical ability. Examples include repetitions of band exercises for the upper body to improve shoulder strength, putty exercise to strengthen hands for in hand manipulation or using a finger ladder when increasing range of motion in the shoulder that ultimately improve reaching ability.
A requirement for billing CPT® 97110 is that the exercises performed must be medically necessary to increase participation during functional activities, ADL, or IADL tasks. Another requirement for billing is that the procedures are administered directly with one-on-one patient care, with a qualified professional, and one unit per 15 minutes of intervention.
Documentation also plays a significant role in accompanying your billing units for this code. Clear documentation helps therapists provide better care with clear communication between treating therapists, insurers and outside medical providers who review the medical notes. Required documentation includes describing the specific deficit you are addressing in the treatment to improve functional performance.
Documentation should also include quantity of exercises performed, quality of performance, the intended clinical outcome, and a clear link to how improving the deficit will progress toward meeting occupational therapy goals and greater independence.
Objective, measurable data should be included throughout the treatment course to serve as evidence for the patient benefiting from the exercises prescribed. Billing for more than one unit may be appropriate for clients that have more complex conditions that may require more time to perform, modify and complete prescribed exercises.
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CPT Code 97110 and occupational therapy
Common occupational therapy services covered under this code include resistance band exercises for strengthening, isometric exercises, free weights, stretches, range of motion exercises, and hand exercises.
Therapists will often combine exercise with a complementing modality such as fluidotherapy that allows a client to perform hand exercises while their arm is being heated in a machine allowing for the therapist to charge for the exercises, CPT code 97110. If no exercise is performed during the modality application, then modalities such as electrical stimulation or ultrasound are billed by the device used versus procedure performed and are billed separately from CPT code 97110.
CPT code 97710 fits into an occupational therapy plan to physically prepare someone for active participation in daily tasks along with helping to increase or maintain physical ability and prevent further physical decline. This includes constant assessment and supervision for how a physical impairment is limiting the client’s functional independence and incorporating necessary exercises to improve overall independence.
Maximizing reimbursement for CPT code 97110
CPT code 97110 is timed, billed one unit per 15 minutes, following the 8-minute rule as required per the insurance plan. Common reimbursement issues include mismatched time per unit or activity billed and missing documentation. Quantity of repetition, what type of exercise and why the exercise was selected should be included in the treatment note to illustrate units billed.
Key documentation elements include defending medical necessity for service, along with the type of exercises or stretches used and patient response to procedures. Documentation should show a direct link from clinical judgment of interventions selected to how the patient will benefit from the exercises to achieve set goals and improve functional outcomes.
CPT Code 97110 and compliance
To adhere to compliance regulations, therapists should ensure documentation includes a start and end time for treatment to accompany your billing units. Within your treatment units, most insurance plans recognize the eight-minute rule set by the Centers for Medicaid and Medicare (CMS) that requires at least eight minutes of direct one-on-one treatment before charging one unit.
Once you ensure your numbers are correct, look at your documentation and that you have a clear link to the medical necessity of interventions, how the patient will benefit from interventions, the type of exercises performed, and how the patient responded to treatment. If the exercise changes or the therapist adjusts the resistance level, there should be documentation to support clinical reasoning behind the adjustment.
Any changes made to the exercises should be performed and documented by the therapist overseeing the plan of care. An assistant or therapy aide cannot change the exercises in any way until collaborating with the overseeing therapist and the collaboration is documented. Not documenting the required information is a compliance risk that may result in a denial of payment or jeopardize authorization for further treatment, such as if a progress note includes outcome scores that do not agree with the information in your treatment notes prior.
Strategies to ensure compliance go back to making sure you understand the required information insurers are looking for in clinical documentation and billing correctly for your direct patient treatment time.
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CPT code 97110 allows occupational therapists to charge for procedures involving exercise to improve physical impairment. We use physical abilities to carry out a daily routine, often not realizing how much we rely on our bodies until we experience an injury or decline that limits our independence.
Occupational therapists have many ways to improve functional participation, and CPT code 97110 helps therapists use exercise to target a specific impairment for improved participation and independence.
Proper billing, correct use of the code, and accurate documentation are the key elements to achieve reimbursement of your services. The American Medical Association is the authority for CPT® codes and provides annually updated descriptions for each code on their website. These codes, along with their official descriptions, are updated annually to reflect therapy innovations.
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