CPT 97112 - Neuromuscular Reeducation

 

CPT 97112 - Neuromuscular Reeducation

 

(Time-based Code)

 

CPT defines 97112 as "Therapeutic procedure, one or more areas, each 15 minutes Neuromuscular Reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities."

 

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 Neuromuscular Reeducation
Medicare notes that this procedure is provided to improve balance, coordination, kinesthetic sense, posture, and proprioception and that the procedure may be reasonable and necessary for impairments that affect the body's neuromuscular system.

 

Some examples of this are poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity.

 

Checks:

  • Does my patient have a problem with balance, coordination, kinesthetic sense, posture or proprioception?

  • Does the service I provide affect the body's neuromuscular system?

  • Did I document the effect these services have on improving the problem with the neuromuscular system? 

 

Documentation Requirements Specific to this Code
Documentation for CPT 97112 should include:

  • Specific body parts treated (specific muscles/joints) 

  • Specific exercises or activities performed

  • The purpose of the exercises as related to the means to achieve a specific functional goal.

 

Provide information regarding volume of exercise to include sets and repetitions, work (if available), time duration, and specific techniques used such as PNF, Feldenkrais, Bobath, etc.

 

Also note equipment used which might include BAPS board, dexterity tools, sensory training, and desensitization methods.

 

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:
When reporting neuromuscular reeducation with an E/M or CMT Code, you must append the code with modifier 59 to make clear the service is distinct or separate from other services performed on the same day.

 

Importantly, when reporting 97112 to BCBSNC, NC State Health Plan (SHP), MedCost, or any plan which utilizes Zelis edits, an you are also billing a CMT code on the same date of service, you must append 97112 with modifier 59 and modifier GP. (List 59 first, followed by GP.)

 

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