Billing & Coding for Extremity Conditions

Question: “I treat a lot of extremity conditions. On some patients I will do soft tissue mobilization on a rotator cuff strain, therapeutic stretching on an inflamed elbow and myofascial release on a contracted and painful iliotibial band all on the same visit. If I spend approx. 45 minutes with the patient, how do I compliantly code and bill for this?

Answer: Let’s begin with a little coding and documentation background. Therapeutic stretching and soft tissue mobilization fall under the category of therapeutic procedures. Therapeutic procedures are a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. The therapist is required to have direct, one-on-one patient contact while therapeutic procedures are being performed. Medicare rules allow physical therapy assistants to perform billable services as long as the supervising physical therapist is on-site.

Manual therapy techniques, CPT code 97140, includes soft tissue mobilization, joint mobilization, manual lymphatic drainage, manual traction and myofascial release. Manual therapy techniques are used to treat restricted motion of soft tissues in the extremities, neck and trunk. Can also be used in an active and/or passive fashion to effect changes in the soft tissues, articular structures, neural or vascular systems. Examples include facilitation of fluid exchange, restoration of movement in acutely edematous muscles or stretching of shortened connective tissue.

Therapeutic exercises, CPT code 97110, is used to develop strength, endurance, range-of-motion and flexibility. Therapeutic exercises can be performed in either an active, active-assisted or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening) approach. The exercises may be reasonable for a loss or restriction of joint motion, strength, functional capacity or mobility that has resulted from an injury or disease.  

Codes 97140 and 97110 are time-based. According to CMS, for physical medicine and rehabilitation services performed on any calendar day that specify time spent with the patient, the following guidelines are used to calculate the number of units reported based on total time:

Time                           Units
8-22 minutes               1
23-37 minutes             2
38-52 minutes             3
53-67 minutes             4

Example #1: 23 minutes of 97140 plus 23 minutes of 97110 equals 46 minutes. This is reported as 3 units.

Example #2: 30 minutes of 97140 plus 23 minutes of 97110 equals 53 minutes. This is reported as 4 units. 

To answer your question, let’s assume you spend 15 minutes doing soft tissue mobilization on the rotator cuff, 15 minutes doing therapeutic exercises on the painful elbow and 15 minutes doing myofascial release on the iliotibial band. This totals 45 minutes, therefore you would report 97140 for 2 units and 97110 for 1 unit.

Common Extremity ICD-10 codes:
M25.511: Pain, right shoulder
M25.512: Pain, left shoulder
M75.01: Adhesive capsulitis, right
M75.02: Adhesive capsulitis, left
M75.51: Bursitis, right shoulder
M75.52: Bursitis, left shoulder
M77.01: Medial epicondylitis, right
M77.02: Medial epicondylitis, left
M77.11: Lateral epicondylitis, right
M77.12: Lateral epicondylitis, left
G56.01: Carpal tunnel syndrome, right
G56.02: Carpal tunnel syndrome, left
G56.03: Carpal tunnel syndrome, bilateral
M70.71: Bursitis, right hip
M70.72: Bursitis, left, hip
M76.31: Iliotibial band syndrome, right
M76.32: Iliotibial band syndrome, left
M76.51: Patellar tendinitis, right
M76.52: Patellar, tendinitis, left
S76.111_: Strain, quadriceps, right
S76.112_: Strain, quadriceps, left
M72.2: Plantar fasciitis
M77.31: Calcaneal spur, right
M77.32: Calcaneal spur, left
Q66.51: Congenital flat foot, right
Q66.52: Congenital flat foot, left

Marty Kotlar, DC, CPCO, CBCS is the President of Target Coding. He is Certified in CPT Coding, Certified in Healthcare Compliance and has been helping healthcare providers nationwide with Medicare, HIPAA compliance, coding and documentation for over 10 years. Target Coding can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – info@targetcoding.com.

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