Therapeutic exercises are movements that are typically performed to prevent loss of range of motion, maintain or improve muscular strength or increase flexibility, following either an injury or surgery.
When billing and documenting for therapeutic exercise, the following must be kept in mind. You must include the body part(s) treated, and should include specific muscle(s) and/or joint(s) to avoid any confusion about each exercise.
The following are some examples of different exercises that should be billed under CPT code 97110:
• Active, active-assisted, or passive range of motion for increased ROM of a specific joint
• Resistance exercises for improved muscular strength, including isometric, isotonic, and isokinetic
• Exercises to improve aerobic or cardiopulmonary endurance, including: treadmill, bicycle, or NuStep
• Any active stretches which are being utilized to improve flexibility.
Therapeutic exercises typically target single parameters, such as improving ROM or increasing strength so make sure you explain the purpose of each exercise and how it relates to a specific functional goal in your documentation. Therapeutic exercises often contribute to an improved ability to perform real-life movements, such as ADLs, work related tasks and sports activities.
However, when working directly on improving real-life movements, then it falls under CPT code 97530 (see below), and should be billed as such.
According to Optum 360° and the APTA, therapeutic activities require the "use of dynamic activities to improve functional performance."
When considering whether the activity you are having the patient perform is classified as a therapeutic activity or if it falls under a different category, here are some questions to ask yourself:
Is this a functional activity, such as climbing stairs?
Will this improve his/her functional performance, in daily life, at work, or in a sport?
Is more than one parameter (strength, coordination, etc.) being addressed with this activity?
Does this activity directly correspond or relate to a specific work or sports task that the patient will be performing once they have fully recovered?
If you answered yes to any of the above questions, then you would bill 97530 for therapeutic activities. Therapeutic activities cover a wide range of functional activities, such as squatting, ascending/descending stairs, walking, bending, lifting, catching, throwing, pushing, pulling, etc.
It is important to note that Medicaid plans only pay for 97530 codes and do not pay for 97110 therefore it should always be verified prior to seeing a patient.
Therapeutic activities also tend to incorporate the use of multiple parameters (balance, coordination, power, strength, range of motion, etc.) into one activity/exercise. When documenting, be sure to document the specific relationship to a functional activity and how it applies to that particular patient.