by Raquel Shumway
November 9th, 2016
From the ChiroCode HelpDesk:
Question: The Doctor says he was told by a billing company a few years ago to avoid the 97112. So he has been doing 97110 instead. They do the items listed in 97110, but often some of the ones in 97112 as well. His question was, should he actually be avoiding 97112? Or is there simply something he needs to be mindful of when using it?
Answer: It isn't that he shouldn't ever use 97112. It is that he needs to understand when it is appropriate. Some chiros have used it inappropriately in the past, thus leading to higher scrutiny by payers.
If a patient has loss of strength, flexibility, or ROM, then 97110 would likely be the right code. There would be a documentation and/or a diagnosis code that lists these kinds of problems, such as muscle weakness or inflexibility. The care plan would need to outline how, for example, the 97110 will restore the lost strength. Then the update evaluations should document if that goal has been achieved.
If a patient has loss of balance, coordination, posture, and/or proprioception due to damage to nerves or muscles, then 97112 might be appropriate. These kinds of problems need to be documented, care plan goals should focus on fixing them, and the evaluation should discuss progress towards these goals.
If the purpose of the therapy were just to help with range of motion, you would need to go back to 97110, but if there was documented balance problems and the therapy worked on such problems, 97112 would be appropriate.
Some payers have policies that say that there must be evidence of nerve damage, such as a stroke, in order to justify 97112. The types of problems that justify 97110 would probably be much more common, so it might appear unusual to bill 97112 more frequently than 97110.