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Hey, greetings, friends and colleagues. It’s Sam Collins, the coding and billing expert for chiropractic, ChiroSecure. And of course, you, as always, we try to bring you some features that allow you to understand things better, get paid better, I think is the ultimate at the HDR Ross network, which I run, that’s really what our job is.
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We’re here to make sure that your office is billing adequately, properly within compliance and also getting paid the maximum. What I wanna focus in on this one is what is the actual difference? Between certain CPT codes. They can be a little bit varied, but very much the same. So let’s go to the slides.
Let’s talk about what is the difference between 9 7 1 1 0 therapeutic exercise and 9 7 5 3 0 therapeutic activities. Of course, they’re different services. They have different values. The value of 9 7 5 3 0 is about 30% higher. Then is the value of 9 7 1 1 0. So we have to look at why is it different?
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What is it about these codes? What are they? Here’s what I’ll start with. When you see someone doing some exercise like this, and I say exercise, but she’s using this heavy rope, what do you call that service, if that’s being done in your office, and you can see this is being done in a physical therapy facility, is what she’s doing a therapeutic exercise?
Is it a therapeutic activity? Heck, for that matter. Is it neuromuscular education? What my point is that this service or this, what she is doing. The coding’s gonna depend on the why they’re doing it, and that is really the differences between these codes because they’re all similar or exercise like ACT active care codes.
But what’s different about them? One thing to keep in mind is with CPT, we have to be careful of how we select codes. You can’t just randomly go that’s like it, or that’s like it. It says here, select the CPT code of the procedure or service that. Accurately identifies the procedure of service, perform.
Do not select a code that merely approximates the procedure. I said it’s like that. So you wanna make sure that is exact. And if you are saying, I’m not sure what that is, then chances are you may need to use an unlisted code. 9 7 0 3 9 or similar, which means it’s not gonna be paid. So I wanna make sure, can we choose the proper code and let’s talk about these two codes in particular.
The first one is 9 7 1 1 0, and you’ll see that code is indicated as therapeutic exercises to develop strength and an endurance range of motion flexibility. You can’t think of it just generically exercise. Strength, flexibility, endurance. Okay, let’s look at 9 7 5 3 0. At the bottom it says therapeutic activities, and it says direct one-on-one, meaning you have to be there.
Which exercise has the same patient contact by the provider? It says, use of dynamic activities to improve functional performance. Wouldn’t doing exercises do that. There’s obviously a lot of crossover here, so let’s be a little bit more definitive about what this is meaning as far as CPT is concerned.
What does the chiropractic profession, the A MA, American Physical Therapy Association and so forth, think of this? Therapeutic exercises are movements and physical activities designed to restore function and flexibility, improves strength and decreased pain. Okay. But it includes, remember when you’re doing exercises, not just the time they’re exercising, but the time you’re with them one-on-one instructing them.
And so it’s gonna be, the supervision not always have to be touching, but being there with them. And it’s to increase or maintain strength, flexibility, and maybe performed either actively, meaning the person does it on their own. Or active assisted where you might be assisting them, maybe help them with a stretch, help them with a weight, or it could be completely passively where you’re doing just a hamstring stretch.
What is it for? Strength, flexibility, endurance. So exercise. I think for the most part, you can think of it as simply, it’s what you think of when you go to the gym or see someone doing that type of rehab, TheraBands and so forth. Would that fit? Exercise? Absolutely. One or more areas, strength, endurance, bikes, treadmills, isotonic, isometric, isokinetic, stretching, realize it encompasses all of those things.
So if you think of it in that way, that’s pretty broad. That’s easy to define, easy to see. So therefore, what is the difference? Let’s talk about what could be a simple exercise, maybe a simple knee to chest stretch, maybe a low back rotational stretch. This, I would certainly say is probably an exercise.
’cause the sole purpose of this is to increase flexibility, therefore it fits. Now, how would you make sure this is implemented? You have to have one-on-one instruction and then be with the patient the entire time. You might be assisting ’em a little bit, but what you cannot do is just leave them in the room.
Maybe watching a video to follow these, it has to be one-on-one with you or a supervised staff person. But exercise, I think is pretty straightforward, and I will tell you it’s the one code you don’t have as much worry about in a chiropractic profession because everyone understands it’s a standard understanding what active care does.
The purpose of it and it need not be to a separate region, unlike some of the passive things like manual therapy and massage. Now, what about therapeutic activities? 9 7 5 3 0 has a much higher value, but yet it’s like exercise and it says therapeutic activities, direct one-on-one, patient contact, and the use of a dynamic activities to improve functional performance.
Functional performance, meaning what it involves, bending, reaching, carrying, the in things. But really, I think more so what you have to think of the difference of a therapeutic activity is more that it’s directed at something specific outcome of a functional activity as opposed to saying, I just wanna strengthen the shoulders.
Okay. But if you have a very specific task where you’re strengthening the shoulders to do an activity, like putting something on a shelf or doing a job that requires it, that makes it more of a therapeutic activity. So here’s the way I want you to think of it. A therapeutic activity is an exercise, but I’ll give an example.
What if you have someone doing abdominal curls and they’re doing abdominal curls to simply strengthen the abdomen ’cause it’s weak? I would certainly say that fits as exercise. However, what if this person, because of the weak abdomen, they cannot get up from a lying down position? They literally cannot, they cannot maintain the posture in that way because of the weak abdomen.
So now they’re doing the. Abdominal curls, not just to strengthen the abdominal muscles, but it’s a very specific, in order for them to get up from a lying down position, there’s the difference. There’s a functional endpoint that we’re doing this with a specific outcome of the purpose, and frankly, that’s why this code is worth more because it’s designed with some specificity as opposed to exercise.
It can be very generic. They could be doing something, just saying, oh, everybody does the same thing, where this is one done specifically for a patient having a deficit. So the reason that you’re focusing on this one is that you have a specific outcome, not a generic outcome. It is certainly worth more. To give an example, it has an RVU of 1.15 compared to a 0.89.
So as I said, close to a 30% difference. That’s why it’s worth more value. So make sure when you’re documenting. That you’re documenting specificity as to what makes it exercise or makes it therapeutic activities. I would suggest many of you, now that you look at it this way, you’re thinking, most of the time that I’m doing this, I actually do have a functional goal that’s specific.
Good document it ’cause it takes more time and understanding to do that as opposed just generically giving everyone exercise. And this is exactly the information we do at our seminars and with our HJ Ross Network. You want one-on-one help that really can dig through this, make sure the value you’re getting paid.
Check the HJ Ross Network. Until next time my friends be well.
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