97110 by General Practitioner or Family medicine in office Visit

SaritaJP21

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Hello,

Request to guide that, can we report 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility) for below scenario ?

In the office visit of Worker's Compensation of California by general practitioner or family medicine, provider documents below paragraph with the heading of therapeutic exercises.

THERAPEUTIC EXERCISES
The patient was personally trained in appropriate warm up, strengthening and stretching exercises. These rehabilitative exercises were reiterated, demonstrated and reinforced; while the patient actively participated. This is also intended to be performed at home on a daily basis. The rehabilitation routine decreases inflammation, increases flexibility and strength of the specific structures in the injury adjacent locale to include both agonist and antagonist muscle groups, intrinsic flexor, extensor and rotary muscles as well as supporting structures. The exercises were intended to increase strength and range of motion and decrease pain. The minimum time required for CPT 97110 was exceeded for this patient.
 

Chelle-Lynn

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Per CMS...

Physicians/NPPs, independent physical therapists, and independent occupational therapists may bill for physical therapy services using the CPT physical medicine and rehabilitation codes.

For situations where the physician/NPP is both the certifier of the plan of care andfurnishes the therapy service, he/she supplies his/her own information, including the NPI,in the appropriate referring provider loop (or, appropriate block on Form CMS 1500). This is applicable to those therapy services that are personally furnished by thephysician/NPP as well as to those services that are furnished incident to their own anddelivered by “qualified personnel”

The following practitioners must bill the A/B MAC (B) for outpatient rehabilitationtherapy services using HCPCS/CPT codes:• Physical therapists in private practice (PTPPs),• Occupational therapists in private practice (OTPPs),• Speech-language pathologists in private practice (SLPPs),•
Physicians, including MDs, DOs, podiatrists and optometrists, and• Certain nonphysician practitioners (NPPs), acting within their State scope ofpractice, e.g., nurse practitioners and clinical nurse specialists.
 
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SaritaJP21

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Per CMS...

Physicians/NPPs, independent physical therapists, and independent occupational therapists may bill for physical therapy services using the CPT physical medicine and rehabilitation codes.

For situations where the physician/NPP is both the certifier of the plan of care andfurnishes the therapy service, he/she supplies his/her own information, including the NPI,in the appropriate referring provider loop (or, appropriate block on Form CMS 1500). This is applicable to those therapy services that are personally furnished by thephysician/NPP as well as to those services that are furnished incident to their own anddelivered by “qualified personnel”

The following practitioners must bill the A/B MAC (B) for outpatient rehabilitationtherapy services using HCPCS/CPT codes:• Physical therapists in private practice (PTPPs),• Occupational therapists in private practice (OTPPs),• Speech-language pathologists in private practice (SLPPs),•
Physicians, including MDs, DOs, podiatrists and optometrists, and• Certain nonphysician practitioners (NPPs), acting within their State scope ofpractice, e.g., nurse practitioners and clinical nurse specialists.
Thanks for the guidance Chelle Lynn. Request to guide that is bellow documentation sufficient for 97110 code assignment, as we are getting this kind of paragraph in the chart ?

THERAPEUTIC EXERCISES
The patient was personally trained in appropriate warm up, strengthening and stretching exercises. These rehabilitative exercises were reiterated, demonstrated and reinforced; while the patient actively participated. This is also intended to be performed at home on a daily basis. The rehabilitation routine decreases inflammation, increases flexibility and strength of the specific structures in the injury adjacent locale to include both agonist and antagonist muscle groups, intrinsic flexor, extensor and rotary muscles as well as supporting structures. The exercises were intended to increase strength and range of motion and decrease pain. The minimum time required for CPT 97110 was exceeded for this patient.
 

mitchellde

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If you are going to bill these services then time spent must be documented in minutes. To say the time limit was exceeded in not sufficient. The provider must document the minute because if it is less than 8 minutes it is not billable. Also I think the area or areas that are the target of the therapeutic benefit needs to documented as well.
 

Chelle-Lynn

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Make sure the documentation supports the provider is working one-on-one with the patient and reflects the total time spent providing exercise to develop strength and endurance. Some of the parameters you may see in the documentation could be work done on a treadmill, using a gymnastic ball, stabilizing exercises, etc. You will see words such as strengthening, endurance, range of motion, etc. Total time or start/stop should be documented.
 
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