Re: [OregonDCs] 97112 (NMRE) denials

[Guest guest]

As the author of the advisory notice that you attached, I should be the one to comment. The notice you forwarded is one I first drafted in 1998. It has been updated, but the copy you have is essentially the same information.

Neuromuscular reeducation is grouped with several other provider based instructional codes. Its title and description imply some form of neurological deficit, such as a stroke, rehabilitation following joint replacement surgery, or other condition with a similar loss of function.

In 2001, AMA CPT described 97112:

From a CPT coding perspective, code 97112 is intended to identify therapeutic exercise designed to re-train a body part to perform some task that the body part was previously able to do. This will usually be in the form of some commonly performed task for that body part. A vignette of the service and its components are included in the following:

A woman has a right CVA resulting in a left spastic hemiplegia. Although she can move her arm, she has no functional use of it, as her increased muscle tone results in a flexion synergy in which she adducts her shoulder, flexes her elbow, and pulls her hand into a tight fist. In order to diminish the spasticity during her daily activities, the provider applies deep pressure, then internally rotates the patient's upper arm, extends the elbows, pronates the forearm, and extends the patient's fingers and thumb. This combination of movements releases the spasm, and with manual guiding from the provider, the patient is able to practice grasping, holding, and releasing large objects.

Some common examples of this service include Proprioceptive Neuromuscular Facilitation (PNF), Feldenkreis, Bobath, BAP's Boards, and desensitization techniques.

Code 97112 is intended to identify neuromuscular re-education designed to re-educate the muscle for some function it was previously able to do and not intended to identify massage to increase circulation, etc.

While I do not have your clinical information in this case to review with the charges, your description would suggest that you are more appropriately performing exercise rehab that would be better described with CPT 97110.

Health Cost Management is a facilitator of IMEs and File Reviews, but also will perform bill review procedures similar to a Third Party Administrator (TPA) where codes and charges are simply reviewed by a computer program. This may be what you have encountered. If you believe that your documentation supports 97112, inclusive of patient/provider contact for 15 minutes (1 unit of time), appeal the denial and submit the chart records that support your position.

At my request, Health Cost Management has submitted another inquiry to CPT Assistant requesting further clarification of 97112.

I hope this helps.

Tom Freedland

In a message dated 6/12/2007 5:10:05 P.M. Pacific Daylight Time, bingonis@... writes:

Dear listmates, My CA has been trying to collect on NMRE services provided which were farmed out to a Beaverton claims management company called Health Cost Management. She has been trying to reach this company for a number of weeks and recently received a call back. The woman who called was very upset that she could not speak with me when she called, obvioulsy she thinkgs that all Chiropractors sit around and collect insurance checks...I digress. She left a message with my CA stating that NMRE should only be performed on stroke victims and went on to say that she would send me an email. I received an email with a document titled "Red Flag CPT Code 97112" written by Freedland. I have attached the document and would appreciate the feedback. I have a rehab room in my practice where I use wobble boards and therapy balls to re-educate the neruomuscular system, is this not NMRE? BinghamHighland Chiropractic

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[Guest guest]

What do you say about vestibular rehabilitation for vestibular disorders??

D WhiteSee what's free at AOL.com.

[Guest guest]

, ATtached is the link to the APTA regarding 97112 on question 8:http://www.aptaco.org/reimbursement/cptcoding.htm#8According to them, it's used for Neuromuscular

reeducation (97112) is used to describe activities related to posture,

balance, proprioception, coordination and/or kinesthetic sense.Hope this helps. Cluen

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[Guest guest]

I'd say that is absolutely 97112. Desensitizing no??

I feel anything that involves proprioception, neuro-muscular involvement or re-training of a previously functional unit can be classified as 97112. Simple strengthening, stretching, mobilizing or exercise that does not have all of the following: component of neurology, function loss, and re-education would be 97110.

In our professsion documentation should be a cinch. The VSC many times involves this reduced amount of neuro input causing a body part to have reduced function. Restore neuro input, re-educate for loss of function= 97112.

ph Medlin, DCSpine Tree Chiropractic1627 NE Alberta St.Portland, OR 97211

Re: [OregonDCs] 97112 (NMRE) denials

What do you say about vestibular rehabilitation for vestibular disorders??

D White

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[Guest guest]

This is similar to a conversation the Pharisees had with Jesus.

They were peeing all over themselves because Jesus healed a guy on the sabbath.

Jesus told them, “Don’t worry, I make time and a half on Saturdays.” Just kidding.

He really said, “The law was made for man, not man for the law...[to acknowledge God’s sovereignty].”

At one time, doctors practiced their art and craft to heal people.

The AMA codified their Dx. And Tx. To be able to communicate with each other and insurance companies.

Now doctors are worrying about treating according to which treatment will be covered rather than which is best for the patient.

And chiorpractic consultants are sitting up late crafting helpful articles to split hairs about whether a NMRE therapy for the neuro and muscular components of an injury are coded correctly or should it be used for a primary neuro condition such as stroke.

How about, “I did the work; the patient needed it; pay the bill...”?

Or is that too hard?

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: <bingonis@...>

Date: Tue, 12 Jun 2007 23:37:29 +0000

< >

Subject: [OregonDCs] 97112 (NMRE) denials

Dear listmates,

My CA has been trying to collect on NMRE services provided which were farmed out to a Beaverton claims management company called Health Cost Management. She has been trying to reach this company for a number of weeks and recently received a call back. The woman who called was very upset that she could not speak with me when she called, obvioulsy she thinkgs that all Chiropractors sit around and collect insurance checks...I digress.

She left a message with my CA stating that NMRE should only be performed on stroke victims and went on to say that she would send me an email.

I received an email with a document titled " Red Flag CPT Code 97112 " written by Freedland. I have attached the document and would appreciate the feedback.

I have a rehab room in my practice where I use wobble boards and therapy balls to re-educate the neruomuscular system, is this not NMRE?

Bingham

Highland Chiropractic

[Guest guest]

-

I would have gotten back to you sooner, but I was drafting another policy. No, actually I was trying to find a specific quote. This comes from Inherit the Wind by Jerome Lawrence and Lee (and was made into one of the all time great movies, and starred Spencer ).

Henry Drummond is addressing the jury: Gentleman, progress has never been a bargain. You've got to pay for it. Sometimes I think there's a man behind a counter who says, "All right, you can have a telephone; but you'll have to give up privacy, the charm of distance. Madam, you may vote; but at a price; you lose the right to retreat behind a powder-puff or a petticoat. Mister, you may conquer the air; but the birds will lose their wonder, and the clouds will smell of gasoline."

I am sure you do not want to go back in time to when our brethren were jailed for "practicing medicine." As we advance as a profession and ask for wider acceptance, we pay a price. If we desire to be included as a covered benefit of third party payers, then we must play by the rules of the game. That includes documenting the justification for the services performed, especially when asking someone other than the patient to pay the bill.

Our direction is now to Evidence Based Practice, which, by its very nature requires an expressed clinical rationale for the services performed.

Life would be easier if it were as simple as you suggest. But then we would need to give up e-mail; well maybe that isn't such a bad idea; and I am still fond of TV of the 1950's (Maverick, Have Gun - Will Travel). Alas, our world is not going to get simpler; but that doesn't stop us from dreaming.

Tom Freedland

In a message dated 6/13/2007 11:06:55 A.M. Pacific Daylight Time, drscott@... writes:

This is similar to a conversation the Pharisees had with Jesus.They were peeing all over themselves because Jesus healed a guy on the sabbath.Jesus told them, “Don’t worry, I make time and a half on Saturdays.†Just kidding.He really said, “The law was made for man, not man for the law...[to acknowledge God’s sovereignty].â€At one time, doctors practiced their art and craft to heal people.The AMA codified their Dx. And Tx. To be able to communicate with each other and insurance companies.Now doctors are worrying about treating according to which treatment will be covered rather than which is best for the patient.And chiorpractic consultants are sitting up late crafting helpful articles to split hairs about whether a NMRE therapy for the neuro and muscular components of an injury are coded correctly or should it be used for a primary neuro condition such as stroke.How about, “I did the work; the patient needed it; pay the bill...â€?Or is that too hard?( E. Abrahamson, D.C.)Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

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