The one I want to give an example to is, one that’s come up quite a bit recently is what is the difference between 9 7 1 1 0 and 9 7 5 3 0.
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Greetings, friends and colleagues. This is Sam Collins, your coding and billing expert for acupuncture. The Profession, acupuncture network of course, and the American Acupuncture Council here to always make sure you have the best and latest information. And one of the things I run into all the time in teaching seminars, but also acting as an expert, is trying to understand what are the differences between certain types of CPT codes.
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The one I want to give an example to is, one that’s come up quite a bit recently is what is the difference between 9 7 1 1 0? 9 7 5 3 0. So let’s go to the slides. Let’s talk about it. What are these two codes? 9, 7 1, 1 0 is exercise, therapeutic exercise 9 7 5 3 0 is therapeutic activities. What is the difference?
How do we understand that? I wanna make sure acupuncturists have a clear understanding, ’cause that certainly can be within scope. Let’s first get into, we have to always make sure we understand the codes well, to choose the right service. Based on the right code, based on the services we’re providing.
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So it says here per CPT that select the CPT code of the procedure or service that accurately identifies the procedure or service performed. Do not select a CPT code that merely approximated. So you can’t say it’s like it. Like I had someone that found out that hot packs aren’t payable by almost all insurances and haven’t been for quite some time.
So he said I’m going to bill hot packs. Infrared heat with the idea being, theoretically any warm body. Emits an infrared portion of the heat spectrum to some degree. That’s not really the intent. Certainly infrared heat is a little bit beyond just a hot pack. So again, we want to be careful of trying to twist things.
If it doesn’t fit exactly, make sure you’re using an unlisted code, which pretty much means it’s not gonna be paid, but use the code that best identifies it. Here we have to remember as an acupuncturist. Can you do more than just deliver acupuncture? Of course, your scope of practice often can be very broad, and I will say certainly look at your state.
If I teach in your state, certainly get a hold of me. We can work on that. Understanding what type of services you can do beyond obviously evaluations, but you’ll often see in your scope it’ll say adjunctive services. The adjunctive services often are very broad. It includes a lot of physical medicine services that might include heat, massage, exercise, and so on.
So do verify your scope. But generally all physical medicine services are generally within scope done with the idea of a traditional medicine slant to it. So let’s take a look specifically at two codes here today. 9 7 1 1 0. You’ll notice as a therapeutic procedure, one or more areas 15 minutes, which means it’s face-to-face time, just like acupuncture and therapeutic exercise Says therapeutic exercise is to develop strength and endurance, range of motion and flexibility.
Okay, so the standard things you do, if you told someone to go out and exercise, what would they think they’re going to improve? I think that’s what we’re seeing with that. Pretty generic, Qigong, if you will, but what about a therapeutic activity? Now you’ll notice the one in the bottom, 9, 7, 5, 3 0 says therapeutic activities, direct one-on-one patient contact by the provider.
So that’s still the same, have to be there. But then it says, use of dynamic activities to improve functional performance. Therein is probably the biggest difference. Exercises generically just to increase strength, flexibility. Therapeutic activities are exercises, but specifically done to create a certain or specific functional outcome.
So 9 7 1 1 0 are movements and physical activities designed to restore function and flexibility. Okay, it. It includes instruction and feedback. So realize when you’re doing this face-to-face, it doesn’t necessarily mean that you’re staring at the person touching them, but you’re supervising, making sure they’re doing it properly, safely, maybe assisting them.
But it does require you be one-on-one. You cannot do exercise with two people at the same time. They can be doing that, but it wouldn’t be this code 9 7 1 1 0 is one-on-one. When you’re with a patient, maybe they’re doing yoga poses, maybe they’re doing tai chi or any type of exercise for strength, flexibility, endurance.
In fact, if you think of exercise generically, it fits almost everything we think of when you go to the gym. Bikes and treadmills, gym equipment, weight equipment, isometric, isotonic, isokinetic, but includes passive things like stretching. Might be assisting the person just in stretching.
So certainly any of that fits. Just make sure you’re documenting what exercises I. How much time you’re spending in doing it. So simple things like knee to chest stretching, maybe a low back rotational stretch, anything like that certainly fits. Notice. These are ones that you might be directing the patient to do.
Now this might be one we probably give them to do it more at home later, but certainly when they’re doing this in the office with you, that is absolutely a billable service. Now, what is the difference of 9, 7, 5, 3 0 exercise? I think we can see pretty easy and straightforward, however. 9 7 5 3 0 says one-on-one patient to improve functional performance.
So this involves functional activities, bending, reaching overhead activities with very specific outcomes to increase a function. So let’s say by example, you had a person that is a grocery store clerk and they hurt their wrist. When you strengthen that wrist, is it just to strengthen or is it to strengthen it to have specific tasks to allow them to do their job at the grocery store?
The same exercise that might be for someone just to strengthen the wrist generically, may be the same for the grocery clerk, but because you’re specifically liking to do a specific task, whether it’s going to be reaching in and out of a bag and lifting items, makes it more an activity. So always think of the outcome, realize all exercises.
Could be therapeutic activities. All therapeutic activities potentially could fit under exercise, depends on the why. So here’s the best way to think of it in choosing it. Look at all these pictures on the right. Could you say to me, oh, Sam, that one is exercise. This one’s a therapeutic activity. We cannot tell from the picture because choosing the code depends on the intent of the task.
So follow me here. If you’re doing abdominal curls, they certainly can be used to strengthen weak abdominal muscles and build as exercise. They come in their stomach muscles are weak. We’re doing abdominal curl strength in the stomach. Great. However, what if the patient is performing the abdominal corals specifically because their abdomen is so weak, they don’t have an ability to rise up from a lying down position or get out of a chair because the stomach is too weak.
Now all of a sudden. Those exercises, yes, they’re strengthening the stomach, but it’s there because we need an outcome that it’s there to perform. Getting in and out of a chair or lying down, that’s the activity and that’s why this is worth more. To give an example, 9 7 1 1 0 has a RVU of about 0.89.
Compared to 9 7 1 9 7 5 3 0, which is 1.15. So you’re gonna see that’s almost a 30% difference. It’s worth quite a bit more because this is designed specifically for that patient, something for them to do, not just generic for everyone. If everyone does the same thing, I’m gonna say, ah, that’s probably exercise.
But best practices determine what is the outcome expected from the task. Is it simply just to strengthen? Or is it a functional performance? When it becomes a functional performance, realize the higher value is you’re designing something specific for this patient’s needs. And I think when you think of most exercises, I think that’s what we do.
Now, obviously if everyone gets the same sheet, the same things, okay? But assuming we’re gonna have some nuanced differences, I think it’s far better to look to make sure we’re choosing the right one, because certainly one is worth quite a bit more. And I want you to be paid what you’re worth. Don’t be afraid to code what you’re doing so long as you document it properly, I will always support you.
That’s what we do at the American Acupuncture Council and the network. To differentiate things. Make sure you have the right resources. That’s what our network does. You’ve been to our seminars, but have you ever thought of, Hey, let’s have an expert on task. I could be part of that. Join our network. We’re with you one-on-one, and you get all our seminars free.
Till next time, my friends, I wish you the best.