Code 97112: friend or fow?

Published: 2010-07-17 15:09:42
Author: Kathy Mills Chang | ChiroEco | April 2010

The proper reporting of neuromuscular re-education (NMR) is one of the more significant coding dilemmas faced by chiropractors. This is partly because many definitions of NMR exist, and there are many different interpretations of these definitions.

While there isnít one universally accepted definition, it generally refers to a treatment technique or exercise performed by an individual with the purpose of improving ó via the nervous system ó the level of communication between the body and the brain.

The NMR process also encompasses proprioceptive training. Proprioception is defined as the sense of the relative position of neighboring parts of the body.

The proprioceptive system provides feedback solely on the status of the body internally. It is the sense that indicates whether the body is moving with required effort, as well as where the various parts of the body are located in relation to each other.

There are clinical indications for providing proprioceptive training by a chiropractor. The more significant quandary to solve, however, is how to report the work youíre doing, and whether that is by the code 97112.

CPT defines NMR as follows: 97112 therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

In describing what services can be included under this code, the American Medical Association (AMA) has clarified that ďsome common examples of this service include proprioceptive neuromuscular facilitation (PNF), Feldenkrais, Bobath, BAPSí Boards, and desensitization techniques.Ē

Given this code is a therapeutic procedure, it requires complete one-on-one attendance during the therapy. Depending on your state rule, that could mean with the doctor or a qualified and properly trained team member.

Because the description of this code includes PNF stretching, itís often billed in chiropractic offices for muscle work performed by a doctor or massage therapist.

The AMA has clarified, saying, the description of the service is more specific.

From a CPT coding perspective, code 97112 is intended to identify therapeutic exercise designed to retrain a body part to perform some task the body part was previously able to do. It is not intended to identify massage to increase circulation, etc.

For this reason, itís strongly recommended you donít use 97112 for muscle-related work within the confines of a chiropractic treatment plan. There are other codes better suited for describing this type of work.

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