Forum - Questions & Answers
CPT® - 97112
Why are they denying 97112 stating incomplete/invalid admitting history and physical report' when they reimbursed it on the 1st and 2nd visit.
Thanks,
Kishore
re: CPT® - 97112
CPT® - 97112 denied as incidental to 97110 which was billed on the same day. Can you Please let me know...
re: CPT® - 97112
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.
Aetna: Neuromuscular Re-education - This therapeutic procedure is provided to improve balance, coordination, kinesthetic sense, posture, and proprioception to a person who has had muscle paralysis and is undergoing recovery or regeneration. Goal is to develop conscious control of individual muscles and awareness of position of extremities. The procedure may be considered medically necessary for impairments which affect the body’s neuromuscular system (e.g., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity) that may result from disease or injury such as severe trauma to nervous system, cerebral vascular accident and systemic neurological disease. Standard treatment is 12 to 18 visits within a 4-6 week period.
Code 97110, therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.
You can see the difference in definition and goals. Ask yourself, “Am I applying this service to simply improve joint mobility or strength or am I attempting to restore a specific function in the patient?
re: CPT® - 97112
So it means the denial is correct??? Sorry i was not able to get to a conclusion... :)
re: CPT® - 97112
Oh thank you soooooo much.... Got this claim reprocessed... :)
re: CPT® - 97112
Probably
re: CPT® - 97112
Oh thank you soooooo much.... Got this claim reprocessed... :)
