CPT 97110 - Therapeutic Exercise

 

CPT 97110 - Therapeutic Exercise

 

(Time-based Code)

 

CPT Code 97110:  Therapeutic procedure using exercises to develop strength, endurance, range of motion and flexibility, each 15 minutes.

 

This is a therapeutic procedure, a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. This procedure requires direct (one-on-one) patient contact by a physician or licensed therapist.

 

This is a time-based code billed in units of 15 minutes, using the eight-minute rule when necessary. If the service is provided for less than 8 minutes, it should not be billed to the payor.

 

Reporting Therapeutic Exercise
CPT code 97110 is defined as therapeutic exercises to develop strength, endurance, range of motion and flexibility. It applies to a single or multiple body parts and requires direct contact with a qualified healthcare professional.

 

Documentation Requirements for this Specific CPT Code

  • You must include the body part(s) treated, specifying the muscles and/or joints. You must also list the specific exercises performed. 

  • Documentation must show objective loss of joint motion (degrees of motion), strength (strength grades), or mobility (levels of assistance).

  • Documentation must show how these therapeutic exercises are helping the patient progress towards their stated objective and measurable goals.

  • The exercise is reasonable and necessary if it is performed for the purpose of restoring functional strength, range of motion, endurance, and flexibility.

  

Checks 
Perform these checks when billing 97110:

  • Does this exercise improve functional strength, range of motion, endurance and/or flexibility?

  • Did I document an objective loss of joint motion (in degrees), strength (in a strength grade) or mobility (in a level of assistance)?

  • Does my documentation have clear, objective goals that are measurable?

  • Did I document how these exercises help reach those stated objective goals?

 

HNS Policies: Documentation/Billing
When performed and billed to a payor, modalities/therapies must be properly documented in the health care record and accurately reported using the most appropriate code.

 

When performed and billed to a payor, modalities/therapies must be medically necessary and consistent with the chief complaint/clinical findings, diagnoses and treatment plan.

 

Documentation in the health care record must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.

 

For ALL modalities and therapies, documentation must include:

  • Type of modality

     

  • Rationale

     

  • Area of application (specific region treated)

     

  • Setting and frequency (as applicable)

     

  • If time based code, actual time service performed

  

During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.

 

There should be a reduction in the use of therapies as the patient's condition improves.

 

Modifiers Needed:
Importantly, when reporting 97110 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, you must append the code with modifier GP.

 

Please click here
for the HNS NCCI Edit - Modifier Help Sheet,
which is a list of therapy codes requiring special modifiers.