Eli's Rehab Report

Published on Tue Mar 14, 2006 PDF

Question: When we teach a patient how to use crutches, should we report 99211 or a more in-depth code? Sometimes this training takes 20 minutes or more.


Montana Subscriber

Answer: Depending on your carrier's guidelines, you should be able to report CPT 97116 (Therapeutic procedure, one or more areas, each 15 minutes; gait training [includes stair climbing]) if the crutch training is part of the therapist's treatment plan (and the physician has approved it).

Most insurers pay about the same for 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) as they do for 97116. Remember: You'll be reporting 97116 based on time, meaning that you'll be reimbursed 0.65 RVUs for every 15 minutes of service compared to 0.57 RVUs for 99211.

Because your practitioner generally administers the crutch training for roughly 20 minutes and you bill 97116 in 15-minute increments, you can't report more than one unit of 97116 based on a 20-minute training session.

Medicare changed the incident-to guidelines for therapy codes. An office employee can no longer provide services like 97116 and use the PM&R physician's name if the doctor and employee have not had the educational training as a therapist.

You Be the Coder and Reader Questions were reviewed by Marvel Hammer, RN, CPC, CCS-P, CHCO, owner of MJH Consulting in Denver.