Wiki billing 98940 and 97112

[nock526@gmail.com]

Hello,

There has been some questioning in my office about billing 97112 with CMT codes 98940-98942. There is a lot of information online stating these two codes cannot be billed together unless appropriately modified and documentation supports they were performed in separate spinal regions, but all of that information is outdated. I currently cannot find that there is a CCI edit with these two codes together, but also cannot find any updated documentation supporting that you can bill them together regardless of the area. Was this a CCI edit previously that has since been removed?

Any updated information or insights would be greatly appreciated!

Thank you!

 

[ynoel70]

Certain payers will have individual restrictions even outside of NCCI edits. However, many chiropractic offices misuse the 97112. This isn't a common service in many chiropractic offices. Generally this is being performed on a post stroke, post TBI...type patient. First make sure you are using the correct code, and then you can verify any payer requirements. This is a timed code and you must list the time spent one-on-one by the provider for only the therapeutic portion of the service (not the set-up or clean-up); some payers require you actually document the start/stop time.

The code, 97112, is defined as Neuromuscular Re-education. This therapeutic procedure is to provide improved balance, coordination, kinesthetic sense, posture, and proprioception to a person with muscle paralysis that is undergoing recovery or regeneration. The goal is to develop conscious control of individual muscles and awareness of the position of the extremities. This procedure may be considered medically necessary for impairments that affect the body's neuromuscular system (e.g., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity) that may be the result of disease or injury such as severe trauma to the nervous system, cerebral vascular accidents and systemic issues.