97112 CPT Code: Know Your Codes
97112 CPT Code Description
97112 CPT Code: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities. Examples include Proprioceptive Neuromuscular Facilitation (PNF), Feldenkreis, Bobath, BAP’S Boards, and desensitization techniques. Neuromuscular re-education may be considered medically necessary if at least one of the following conditions is present and documented:
- the patient has the loss of deep tendon reflexes and vibration sense accompanied by paresthesia, burning, or diffuse pain of the feet, lower legs, and/or fingers;
- the patient has nerve palsy, such as peroneal nerve injury causing foot drop; or
- the patient has muscular weakness or flaccidity as a result of a cerebral dysfunction, a nerve injury or disease, or has had a spinal cord disease or trauma.
The CPT 97112 procedure requires direct one-on-one patient contact by a physician or therapist. The descriptor for this procedure reflects 15-minute intervals. If a procedure lasts more than 15 minutes, the CPT code can be reported for each 15-minute interval.
When to Use 97112 CPT Code
CPT procedure code 97112 Neuromuscular re-education, does not describe chiropractic manipulative treatment and the services are not mutually exclusive. Chiropractic manipulation (CMT) is described by codes 98940, 98941, 98942, and 98943. From a CPT coding perspective, in certain circumstances, it may be appropriate to report CMT procedures and CPT code 97112 on the same date of service. For example, if separate therapeutic procedures are being addressed by different techniques, then it is appropriate to report these services separately.
If a chiropractor is performing therapeutic procedures, such as neuromuscular re-education, in a group of two or more individuals, only CPT code 97150 should be reported. Time and/or the number of therapeutic procedures is not defined in this code. Two or more individuals constitute a ‘group.’ If this procedure is performed with two or more individuals, then only report 97150. Do not code the specific type of therapy in addition to the group therapy code. Note that flexion distraction work is more appropriately billed as Chiropractic Manipulative Treatment. If the ‘deep muscle stimulation’ actually a passive type of electrical stimulation, then it would be more appropriately billed with 97014.
Billing for 97112
In order to be reimbursed for an adjustment and neuromuscular re-education on the same date of service, they must be performed on different areas of the body. Add a -59 modifier to the CPT 97112 code to code for neuromuscular re-education performed on a separate anatomic area from the adjustment. Don’t forget to clearly document the time since 97112 are time-based codes.
- Medicare National Facility Total Payment – $35.64
- Medicare National Non-Facility Total Payment – $35.64
Example of 97112
A woman has a right CVA resulting in a left spastic hemiplegia. Although she can move her left arm, she has no functional use of it, as her increased muscle tone results in a flexion synergy in which she adducts her shoulder, flexes her elbow, and pulls her hand into a tight fist. In order to diminish the spasticity during her daily activities, the provider applies deep pressure to the patient’s biceps. The provider then internally rotates the patient’s upper arm, extends the elbows, pronates the forearm and extends the patient’s fingers and thumb. This combination of movements releases the spasm, and with manual guiding from the provider, the patient is able to practice grasping, holding and releasing large objects.
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We hope that this article has provided basic guidelines about the 97112 CPT code. If you are looking for overall billing and coding services you can refer to E2E Medical Billing Services. Our accurate and affordable billing services will eliminate billing and coding errors and will increase your practice collection. To know more about our medical billing and coding services, call us at 888-552-1290 or write to us at [email protected]