Neurology & Pain Management Coding Alert

Question: How is neuromuscular release defined? How much time does it require, and what techniques or tasks must be performed on a patient to qualify?

Virginia Subscriber  
Answer: According to CPT, 97112 (therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception) is a therapeutic procedure defined as a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. To bill this procedure, a physician or therapist is required to have direct (one-on-one) contact with the patient. These services may be provided incident to a physicians services, and must therefore be directly supervised by the physician in his or her office.
 
Medical necessity for this therapy is determined on a case-by-case basis. According to Cigna Medicare local medical review policy (LMRP) 96-024, which covers Medicare Part B providers in North Carolina, The expected goal that is documented in the treatment plan, effected by the use of each of these procedures, will help define whether [neuromuscular release is] reasonable and medically necessary. Therefore, since any one or a combination of more than one of 97110, 97112, 97113 or 97530 may be used in a treatment plan, documentation must support the use of each code as it relates to a specific therapeutic goal. Other Medicare carriers offer similar guidelines.
 
For 97112, the standard of care is 12 to 18 visits within a four- to six-week period. According to Cigna LMRP 96-024, Coverage beyond this frequency and duration may require documentation supporting the medical necessity of continued treatment.
 
As indicated in the code descriptor, documentation must indicate that there was neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception for the area(s) treated. Because this is a time-based code, the physician or therapist should document the start and stop times, and bill units accordingly. For instance, if the neuromuscular release required a documented 30 minutes, report 97112 x 2.  
Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology at the  University of Pittsburgh School of Medicine; and Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, consultant-owner and trainer for A+ Medical Management and Education in Egg Harbor City, N.J.