Eli's Rehab Report
Find Out What Justifies 97112
Question: We often bill the code for neuromuscular re-education of movement for our cerebral palsy patients, but our new office manager says he isn’t sure we’re meeting the requirements for this code. Can you fill me in on the limitations for billing 97112?
Answer: Code 97112 (Therapeutic procedure, one 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) identifies a therapeutic procedure that CPT® defines as a “manner of effecting change through the application of clinical skills and/or services that attempt to improve function.” The therapist must have one-on-one contact with the patient to bill for this procedure.
These services may be provided “incident-to” a physician’s services, in which case the physician would have to supervise the therapist directly in his office.
Most carriers allow a maximum of 12 visits per month for this service, which uses stretching, strengthening and specialized biomechanical exercises to allow patients to find new ways to rest, hold, balance and move their bodies. Most carriers dictate that you cannot report more than two units of 97112 at any given session.
According to Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI, Sr. Instructor, CodingCertification.Org, operating out of Egg Harbor City, New Jersey, the definition of a “provider” is a PT, OT, PTA, OTA, or MD, not a rehab aide, personal trainer, athletic trainer, etc. You should also check your state regs to verify that your provider is able to provide these services, she advises.
You could also go into the CMS 8 Minute Rule where you don’t have to have a full 15 minutes to bill another unit of the code.
Resource: For further reading on this matter, you can check out this article www.webpt.com/blog/post/medicare-8-minute-rule-so-simple-yet-diabolically-complicated
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