Wiki CPT 97110 vs. 97530

[melissa.rowe]

Hello everyone!

We are just about going batty over here trying to figure out exactly what can be billed under the CPT code 97530. Our therapists (PT and OT) tend to use 97110 and 97530 interchangeably, or they use 97530 for anything that may be considered an "activity" (ex: going to a movie, playing cards, etc). , seeming to be a "catch all" therapy code, that is used when it doesn't fit 97110. Is this correct?

We (billers and therapists) have very differing opinions as to how these 2 codes are used, so I am looking for easy to understand guidelines, in hopes we can get everyone on the same page.

Also (a bonus question), can you use 97110 with 97150 in the same session if there is a clear distinction in the documentation?

Thank you so much- your help is appreciated!

 

[ssebikari]

In 97110 -Therapeutic exercises -The health care provider and/or patient perform therapeutic exercises to one or more body areas to develop strength, endurance, and flexibility. Where as 97530 - Therapeutic activities -The health care provider uses dynamic therapeutic activities designed to achieve improved functional performance (e.g., lifting, pulling, bending).

Please note that both 97110 and 97530 are timed codes (billed per 15 units) and require direct face to face interaction with therapist/or healthcare provider.
True 97110 with 97150 (group therapy) can be performed during the same session if there is a clear distinction in the documentation. A modifier 59 should be appended to the column 2 code which in this case is 97110 as these two procedures are mutually exclusive. Also note that 97150 is an untimed code and can only be billed with 1 unit per session.
I hope this helps!!

 

[melissa.rowe]

We've been explaining that it's important to document the why of the treatment, since it seems so muddled. Lifting could be function or strengthening, bending could be function as well as flexibility, etc.

Issues now are arising on whether or not "set up" is billable. Patient in standing frame for 45 min, and therapy wants to bill 97110 for 4 units because they transferred him to and from his w/c.

Is there a code for Ohmigod.I.have.a.headache.from.this?