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Massage Today
April, 2003, Vol. 03, Issue 04

CPT Codes: To Use, or Not to Use?

By Ed Denning, MEd, LMT

CPT Codes 97001 and 97002

97001: Physical therapy evaluation

97002: Physical therapy re-evaluation

I wrote to the American Medical Association (AMA) Information Services Committee in 1998 regarding the use of 97001 and 97002 by massage therapists.

The committee's first response left room for wide interpretation. In April 2002, I wrote a follow-up letter that resulted in the following response:

CPT does not specify credentials an individual practitioner must have to report a given service, (however) the services are reported in the overall context of state licensure. Only those individuals licensed by a particular state to perform the described services should use the codes to report the services provided. Thus, the therapist providing the service must be state licensed to practice physical therapy, as the evaluations and re-evaluations identified in the code descriptor are specifically limited to physical therapy evaluations and re-evaluations. As licensure varies from state to state, the applicable state laws and requirements determine who may perform specific types of services, including physical therapy evaluations and reevaluations.

This response states clearly that only physical therapists are qualified to use these two codes. 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 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.

CPT Code 97112

Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement; balance; coordination; kinesthetic sense; posture; and proprioception.

In March 2001, I wrote another letter to the AMA Information Services Committee regarding CPT code 97112, requesting the following information:

  • Please explain/define the types of procedures that would fit this definition.
  • Please explain/define the meaning of "neuromuscular re-education."
  • The work of massage therapists could positively affect balance, coordination and proprioception. Does that qualify massage therapists to use this code?

The AMA response included the following:

From a CPT coding perspective, code 97112 is intended to identify therapeutic exercise designed to re-train a body part to perform some task that the body part was previously able to do. This will usually be in the form of some commonly performed task for that body part. A vignette of the service and its components 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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