CPT Codes and Isokinetic Reimbursement


 

97110 Therapeutic activities one or more areas (strength, endurance, flexibility, ROM) each 15 minutes

 

97112 Neuromuscular reeducation, each 15 minutes

 

97116 Gait Training, each 15 minute area

 

97530 Functional activities one area, 15 minutes

 

97531 Each additional 15 minutes

 

97535 Self care / home management training, each 15 minutes

 

97750 Physical Performance test and measurement with written report each 15 minutes

 

95833 Muscle testing, manual (separate procedure) with report: total evaluation of body, excluding hands

 

95834 Muscle testing, manual (separate procedure) with report: total evaluation of body including hands

 

95851 Range of Motion (ROM) measurements and report (separate procedure) each extremity excluding hand.

 

95852 Range of Motion measurements and report (separate procedure) hand, with or without comparison with normal side

 

97720 Extremity for strength, dexterity or stamina: initial 30 minutes, each visit

 

97721 Each additional 15 minutes

 

97752 Muscle testing with torque curves during isometric and isokinetic exercise: mechanized or computerized evaluations with print out

 

97145 Physical medicine treatment to one area, each additional 15 minutes


 
 
 

How can I assure reimbursement for isokinetics?

To assure effective rehabilitation, you need to know, communicate and prove each of the following points - isokinetics gives you the answers.

  1. What is the clinical status of the patient and how does it influence function?
  2. What is the most appropriate treatment for the patient?
  3. How much treatment will be required?
  4. Has the patient been rehabilitated?
  5. That there is NO less intensive or more appropriate evaluation or treatment alternative.

Issue 1:
What is the clinical status of the patient and how does it influence function?

Disease leads to impairment, impairment leads to functional limitations and functional limitations lead to disability. Physicians, therapists and athletic trainers have relied on isokinetic testing for quantification of musculoskeletal performance impairments. The impairment is expressed as a deficit in a muscle’s ability to produce force, perform work,or generate power. All the referenced studies use isokinetic assessments to establish baselines and goals for criterion based rehab programs.

Issue 2:
What is the most appropriate treatment for the patient?

The referenced studies document treatment programs for many common pathologies. When used in conjunction with evidence-based protocols, the isokinetic data allows the clinician to make the appropriate changes to the clinic activity portion and/or the home based portion of the program. The isokinetic data may also show that a patient is no longer responding to therapy or that therapy should be discontinued.

Issue 3:
How much treatment will be required?

These studies document that even with complex problems, ACLs, shoulder impingement, arthroscopic subacromial decompression, rotator cuff and ankle instability, that there are fairly consistent and predictive time frames for returning to different levels of function.

Wilk (1992) documents the status of 250 ACL reconstructed knees at 12 weeks post-op. Timm (1988) shows the results after an average of 8.9 weeks of rehab for post-surgical knees.

Issue 4:
Has the patient been rehabilitated?

All the studies show a correlation between the rehab program, isokinetic data and return to functional activities. The study by Timm (1988) documents that isokinetic exercised based programs are more efficient and effective than non-isokinetic programs. Wilk (1991, 1992) follow-up studies with ACL patients 12 weeks and 6 months post-op document successful rehab programs. The study by Ambrosios (1994), showed the average therapy sessions for a non-surgical group was 4.39 weeks versus 7.59 weeks for the surgical intervention group. The cost of therapy was twice as much for the surgical group. Both groups achieved a high return to work rate: surgical 84%, non-surgical 98%.

Issue 5:
Is there a less intensive or more appropriate diagnostic or treatment alternative?

No. Some consider a manual muscle test as an alternative for measuring strength. Many references to the problems associated with a manual muscle test are cited in Wilk (1991) and Kulman (1992). These problems include consistency in grading and method, subjectivity in reporting, and poor inter-tester reliability. Also, manual muscle tests are performed statically, whereas isokinetic testing renders objective reliable data regarding muscular performance during a dynamic contraction.

[“...isokinetic testing renders objective reliable data regarding muscular performance during a dynamic contraction.”]
(Wilk 1991)

The medical providers that utilize isokinetics are telling the insurance companies that they want to control costs and manage cases objectively towards a positive outcome. Insurance companies that reimburse for isokinetic tests are telling providers they expect objective case management.