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CPT Codes: To Use, or Not to Use? Six Ste ps to He lp You


Establish a Six Figure
By Ed Denning, MEd, LMT Practice
Te am W ith Pro Athle te s: A
CPT Codes 97001 and 97002 W in For Eve ryone
Don't Adve rtise W hat You
97001: Physical therapy evaluation Do, But W hat Your C lie nt
R e ce ive s
Use Woman Who Is Suing To 97002: Physical therapy re-evaluation The Inside -O ut Paradigm :
Your A dvantage The Intak e Inte rvie w
Youve probably se e n ...
I wrote to the American Medical Association (AMA) Information Services Committee in 1998 Equipm e nt Am ortization
A New Chapter Begins regarding the use of 97001 and 97002 by massage therapists. 101
Today is the first day of ...
Transform Your Mind, The n
Lost A Sale, But Initial Phone The committee's first response left room for Mark e t Your Busine ss
Consultations A Big Part Of
Brilliant Customer Service wide interpretation. In April 2002, I wrote a C PT C ode s R e ve ale d
I just got finishe d with a ... follow-up letter that resulted in the following Pe rson-C e nte re d C are :
response: W hy It Matte rs
Your Back up Plan: W he n
CPT does not specify credentials an Life Inte rrupts Your Practice
individual practitioner must have to First Annual Am e rican
Massage Job Fair
report a given service, (however) the
services are reported in the overall
context of state licensure. Only those
individuals licensed by a particular
receive advanced
state to perform the described
notice of future
quick links
services should use the codes to webinars!
C UR R ENT ISSUE
report the services provided. Thus,
PR EVIO US ISSUES the therapist providing the service
NEW S must be state licensed to practice
INDUSTR Y NEW S physical therapy, as the evaluations
C O LUMNISTS and re-evaluations identified in the code descriptor are specifically limited to
BR O W SE EDITO R IAL TO PIC S physical therapy evaluations and re-evaluations. As licensure varies from state to
W EBINAR S
state, the applicable state laws and requirements determine who may perform
specific types of services, including physical therapy evaluations and reevaluations.
newsletter
NEW S UPDATE This response states clearly that only physical therapists are qualified to use these two codes.
TO YO UR HEALTH Massage therapists should not use these codes unless they are physical therapists by
licensure; even then, such use would be under the restrictions of the physical therapy licensure
DEALS & EVENTS
of the state in which they practice.

The AMA writes and produces the only CPT manual used in the U.S., and are the final arbiters of
a given code's meaning. In this case, its initial explanation was later corrected/modified,
resulting in a recommendation against use by massage therapists. This is why your coding
information needs to be updated annually. Codes can and do change in meaning and
interpretation; new codes are added, and old codes are deleted.
resources
CPT Code 97112
ABO UT MT
AUTHO R GUIDELINES
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of
C LASSIFIEDS movement; balance; coordination; kinesthetic sense; posture; and proprioception.
EDITO R IAL C ALENDAR
MEDIA GUIDE In March 2001, I wrote another letter to the AMA Information Services Committee regarding
MASSAGE MAR T CPT code 97112, requesting the following information:
SC HO O LS & EDUC ATIO N
Please explain/define the types of procedures that would fit this definition.
FEEDBAC K
Please explain/define the meaning of "neuromuscular re-education."
The work of massage therapists could positively affect balance, coordination and
Alternative Health News proprioception. Does that qualify massage therapists to use this code?
Treatment
Herbal Medicine
of Type Continues
1 to
Evolve
Diabetes Mellitus: The Latest The AMA response included the following:
Product m anufacture rs,
Breakthroughs
industry
The re arepartne
now m rs,ore
distributors
than 29
and
m illion
practitione
diabe tics
rs in
work
the as
U.S.
a From a CPT coding perspective, code 97112 is intended to identify therapeutic
colle 10%
and ctive of
Traditional
the m have C hine
Typese exercise designed to re-train a body part to perform some task that the body part
He The
1. rbal incide
Me dicine
nce (TC
hasHM)be e n was previously able to do. This will usually be in the form of some commonly
com m
incre asing
unityintoreproduce
ce nt ye ars
high at
an e pide
quality TCmHM
ic rate
pre.scriptions performed task for that body part. A vignette of the service and its components
that bring low-risk he althcare
to thousands of patie nts
are included in the following:

A woman has a right CVA resulting in a left spastic hemiplegia.


Although she can move her arm, she has no functional use of it, as
her increased muscle tone results in a flexion synergy in which she
adducts her shoulder, flexes her elbow, and pulls her hand into a
tight fist. In order to diminish the spasticity during her daily activities,
the provider applies deep pressure, then internally rotates the
patient's upper arm, extends the elbows, pronates the forearm, and
extends the patient's fingers and thumb. This combination of
movements releases the spasm, and with manual guiding from the
provider, the patient is able to practice grasping, holding, and
releasing large objects.

Some common examples of this service include Proprioceptive Neuromuscular


Facilitation (PNF), Feldenkreis, Bobath, BAP's Boards, and desensitization
techniques.

Code 97112 is intended to identify neuromuscular re-education designed to re-


educate the muscle for some function it was previously able to do and not
intended to identify massage to increase circulation, etc.

My Interpretation

Massage therapists certified in PNF stretching can use this code to report that service; certified
Hellerwork practitioners also can use this code to report their work. Massage therapists might
interpret their ability to desensitize as fulfilling another aspect of this code. Such an
interpretation may or may not result in payment and would be stretching the intention of the
code. This code is definitely not referring to neuromuscular therapy in any way. The majority of
massage therapists should not use this code.

CPT Codes 97124 and 97140

97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including
effleurage, petrissage and/or tapotement (stroking, compression, percussion).

97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage,


manual traction), one or more regions, each 15 minutes.

In March 2002, I wrote a letter to the AMA Information Services Committee seeking the
following information:

Massage therapists commonly use 97124 or 97140 to describe their work; please explain
the meaning of each of those codes.
How would a massage therapist know which code to use to describe their work?

The AMA response follows:

From a coding perspective, if the therapist is performing therapeutic massage in


order to increase circulation and promote tissue relaxation to the muscle(s), then
code 97124 Therapeutic procedure, one or more areas, each 15 minutes;
massage, including effleurage, petrissage and/or tapotement (stroking,
compression, percussion) should be reported.

If the therapist is performing massage as a manual therapy technique in order to


increase active pain-free range of motion, increase extensibility of myofascial
tissue and facilitate the return to functional activities, then code 97140 Manual
therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage,
manual traction), one or more regions, each 15 minutes should be reported.

My Interpretation of Codes 97124 and 97140

97124 is for increasing circulation and to promote tissue relaxation to the muscles. The specific
techniques involved would be effleurage, petrissage and/or tapotement. This code is reported
in units of 15 minutes. If your treatment is based on or consists of a basic relaxation massage
(Swedish massage), this is the code to use.

97140 is used to describe therapy which increases active pain-free range of motion, increased
extensibility of myofascial tissue and facilitates return to functional activities. This code is
reported in units of 15 minutes. This code would be used for the techniques stated. It would
include neuromuscular therapy, positional release, stretching and nearly any therapeutic
technique performed manually for the purposes mentioned in the first sentence.

Caution: There are coding strategies going around which have the apparent purpose of billing
for higher amounts of money by using multiple codes to describe the therapy session. Such
coding decisions are not that difficult to make. What did you actually do in the session? How
many units of time did you spend doing 97124? How many units of time did you actually spend
doing 97140? Could a client tell when you had transitioned from one treatment code to
another?

Do your clinical notes reflect the techniques for which you are coding? Can you justify your
billing by clear delineations within your clinical notes? What was actually performed within the
session determines the billing that takes place.

I believe that the vast majority of massage therapists cannot justify the use of 97124 and
97140 within a single treatment session, based on their clinical notes. If you choose to bill
using multiple codes, you will need to spend a considerable amount of time writing clinical
notes to support your billing practices.

CPT Code 97530

Therapeutic Activities, direct (one-on-one) patient contact by the provider (use of dynamic
activities to improve functional performance), each 15 minutes. I wrote yet another letter to the
AMA requesting the following information:

Please explain/define the types of procedures that would fit this definition.
Please explain/define the meaning of "dynamic activities."
The work of massage therapists is often both direct and for the purpose of improving
functional performance. Does that qualify massage therapists to use this code?

The AMA response included the following paragraph:

From a CPT coding perspective, code 97530, Therapeutic activities, direct (one on
one) patient contact by the provider (use of dynamic activities to improve
functional performance), each 15 minutes, is used to report dynamic therapeutic
activities. Dynamic therapeutic activities include the use of multiple parameters,
such as balance, strength, and range of motion, which are designed to achieve
improved functional performance. Examples include lifting stations, closed kinetic
chain activity, hand assembly activity, transfers (chair to bed, lying to sitting, etc),
and throwing, catching, or swinging. This procedure requires direct (one on one)
patient contact by a physician or therapist and is reported per each 15 minute
intervals that the therapeutic procedure is performed.

My Interpretation

This code is not recommended for use by massage therapists. Dynamic activities to improve
functional performance refers to a series of movements to perform specific functions. The series
of movements is therapeutic in nature; it is planned and specific.

An example would be a series of movements designed to gradually increase flexibility, strength


and coordination through the use of graduated weights. The action is designed to simulate
related activities such as picking up a plate and lifting it up into a cupboard, picking up a
hammer and placing it in another location, etc.

97530 is a code used to report a series of movements involving flexibility, strength and
coordination specifically designed for recovery of everyday functionality. This code is intended
for use by occupational therapists who receive the specific training needed to design
therapeutic activities. If you have not received that specific training, you should not use this
code. (A weekend seminar is insufficient.)

Editor's note: Mr. Denning notes in his article that billing codes are subject to annual change,
and as Massage Today reported recently, new codes specific to alternative therapies are in the
works. If you are currently or plan on using codes to bill for services, do your homework!

Ed Denning is a licensed massage therapist in Ohio. He is coordinator of the massage therapy


program at Stark State College of Technology, and also serves on the Massage Therapy
Advisory Committee of the Ohio State Medical Board.

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