Get an understanding of the nuances and differences between these two therapeutic services. 

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Hi, everyone. Welcome back, or I should say welcome. And thank you for being with me. This is another addition to make sure your practice is always thriving and growing. Thank you to ChiroSecure. This is your coding and billing expert, Sam Collins, and this edition, I want to focus in on some of the active care and therapy codes that I think are often very confused by.

Have you ever thought of what is the difference between like manual therapy, massage, or today? What we’re going to focus on is what does the difference between therapeutic exercise and therapeutic activities? How are they different for those of you’ve been around a while. You can remember when we didn’t have a therapeutic activities, we call it kinetic activities and they update it.

So what are the differences? Let’s go to the slides. Let’s start to give you some information that hopefully you can take. So the therapeutic exercise and therapeutic activities have a lot of similar. But they are different and one has a much higher value. So let’s focus in on what we’re looking at and why.

And you’ve heard me talk of this before, but I want to focus in on. Chiropractic number one is the main thing to deal with low back neuromuscular problems. But coupled with exercise, according to best practices is always going to be the better resource to make sure your patient gets the best outcome. In addition, it’s less problematic than dealing with passive care.

So if you’re focusing a lot on the massage and manual therapy, that’s great during the acute phase, but what about the office? What about dealing with a separate area? That’s really going to be the problem that we run into. So I’m going to give you a focus here to look at this differently and focusing on what’s good for your patient, but also good for your practice.

So take a look. The problem, the left here is from the Cigna policy for chiropractic the Cigna policy. 2 78 and it says the provider should attempt to integrate some form of active care as early as possible. In other words, what they’re saying is you should be doing active care things as quickly as you can.

And deemphasizing the past is not to say that passive is not having some. But the bigger factor is the rehab, the strengthening. And so they’re saying right here to do it as early as possible. In fact, the second paragraph notice it says the utilization of passive modalities is considered medically not medically necessary because the service is just during the acute phase.

Anything beyond that becomes problematic. So let’s focus on active. In fact, here’s what I will tell you about what the insurance is essentially saying is don’t build a passive therapy. That is one worthless. Less effective in the longterm and you have to have the whole separate area. Active care. Does it?

In fact, if you look here in the middle of this is from Evercore. If you go to the fourth bullet down, it says this treatment progress. Once you’d see an increase in the active regimen, and even under here under the state farm regulatory, it says the same thing, range of motion and muscle re-education exercise to restore appropriate muscle control and support the cervical region in patients with acute whiplash disorder.

So again, the focus on the exercise or the rehab. What are these active care codes? There’s four, but I want to focus in on two of them today. Therapeutic exercise 9 7 1 1. And therapeutic activities, 9 7 5 3 0. And what are the differences? What are the nuances? And I think this is where most people are confused.

I’ve taught seminars now for 25 years, I’ve become the expert when it comes to coding and billing, state boards, insurance companies, the VA all contact me. So I want to pass it on to you and say what is the difference? Because I think we lack a good understanding. Think that during your PT course in chiropractic calls, which has 120.

I didn’t really learn this. I would say for the most part, not really. So we have to do things above and beyond that, but here’s the problem you ever watched? The show? The bachelor, I’m embarrassed to say I’ve seen a few episodes, not many, but I’ve seen a few and you’ll notice on the show. It’s confusing.

So one time when I was watching the show, I was thinking about CPT codes. I know. But I realized they’re the same. You remind me of the CPT codes, the bachelor, because you tend to be ambiguous and overlapping and not clear what your intent is. Have you ever watched the bachelor you want, I’m talking about that being said, by example, the confusion here is look at what this person is doing.

They can see they’re in a PT clinic, notice the tables and all this there, and she’s doing that rope exercise. That’s very popular. Now. Now, what would you say she is doing? What would you determine that. Would it be a therapeutic activity? 9 7 5 3 0 or therapeutic exercise diets in 1, 1 0 or neuromuscular education.

I’d say one, one and two. What do you think the reality is? It potentially could be any one of those because the purpose is more about the code. If the focus is on just strengthening, that would be extra. But if the focus was on a functional activity, because her job requires her lifting things, it becomes a therapeutic activity.

So think of the functional side makes it an activity. If it’s just for strength or flexibility, exercise, neurochemistry education, live, doc, talk about that in another class, but it would be, for instance, balance coordination. So the difficulty is you could have someone doing this and then another person doing the same thing.

They could be coded differently based upon the purpose of it. So let’s talk about exercise 9, 7 1 1 0. It says this procedure includes instruction, feedback, and supervision. So one-on-one with the patient, making sure they’re doing it right, making sure you’re following up with them, doing the proper positioning, getting the full effort and then supervising for exercises to, for their condition, including to maintain flexibility and muscle strength.

And that’s pretty much it. Think maybe going to the gym, what am I trying to do? And get stronger. Yeah, more flexible, maybe build more endurance. And this could be in a lot of different ways. It could be completely active where the patient’s doing it on their own you’re supervising or active assistant where you’re.

Or passive where you’re just stretching the patient is considered medically necessary for any loss of motion, strength, functional capacity to extent, but it’s more about increasing just strength, flexibility. Now be careful exercise should not be used or coded just because a person goes in the room and works out.

It’s got to make sure that there is an active portion with you or staff. That’s actively supervising it to make sure it’s done properly. So exercise is just what you think. Strength endurance range of motion. So a bike, a treadmill, gym equipment, weights, isotonic, isometric, and so on, are all going to be exercise.

This could include simple stretching like you see, or maybe someone has upper cross syndrome, or how about doing something like this is from our friend web exercises. But look at these ones, the Bruegger’s the head retraction, the floor angels, or the Blackburn to think of how many people have difficulty, where they stand against the wall.

They can’t fully bring their arms back and time. Most camp we should. Why do you think most people have upper back pain, that particular syndrome. So doing these exercises are to restore that this would be certainly exercise. And how about documenting in this way? Because it’s in the chart, it’s easy to see what you’ve done.

Just indicate the sets and the reps, because for documentation purposes, how do I document exercise? Let’s take a look at what an insurance has said about it, and it says here to be formally addressed. The proper utilization of these codes requires that the daily treatment documentation and. The specific body part, what am I treating low back neck, whatever.

And the type of exercises. Whether it’s weight training TheraBands, but you want reps sets if it’s a robot condition. In other words, describe it. And along with that, the time now you’ll notice here. It says actual clock time, which is fine. You can say I went from five 15 to five 30, but you can also put, I did 15 minutes.

What you do have to have is the time that’s. To face with the patient. And remember the eight minute rule does apply. So exercise is pretty straightforward, strength, flexibility, endurance, and it could be almost all of those factors combined. How about though? What is therapeutic activities? How that.

And this is where I think the confusion is the definition has it’s written in the CPT manual, says therapeutic activities is direct one-on-one patient contact the use of dynamic activities to improve functional performance. So here’s the thing, a dynamic activity is going to be exercise like, but it’s more with the outcome.

So it’s really the design of the program and the purpose of the exercise, if you will, the reality is a therapeutic activity for the most part, an actual. It is, but it’s an exercise, very specific to deal with a specific functional deficit of an activity. So meaning a person lifting a box from the floor.

By example, if I just have a person doing a devil lift, cause I want to strengthen the whole. I’ll say exercise, I’m sure it’s in the low back. But if the purpose is to have the ability for them to do that task, to lift things from the floor, it becomes an activity. And the difference is really by design.

If you think of it, I bet most of you probably are doing more therapeutic activities than you are exercise, but I’m not trying to talk you into it. I’m just saying chances are you’re designing something specific to your pain. And their needs for their life and lifestyle. So the procedure involves using functional activities, bending, lifting, carrying.

Sometimes you hear them say the. Weightlifting is that I’m doing curls, but again, it’s more the task orientation. So therapy activity says it involves the use of functional activities, bending, lifting, reaching, carrying, and so on to improve functional performance in a progressive manner, much like exercise, but it’s a performance and they’re directed at a loss of restrictional ability or an inability to do a task.

It should be appropriate if the patient has completed exercise. And now one thing to. In a way, exercise leads to a patient being due for more functional activity. Potentially the exercise is to stabilize it just enough to be able to get to do a little bit more. So it’s more about the functional end of it and that specific outcome.

So if you’re documenting a therapeutic activity, the documentation and the ideas more about what is the functional outcome you’re looking for, not just, oh, I want the hamstrings more flight. But I want them more flexible so that I can touch the floor and pick up an item from work or home for that matter.

So my example, look at all these different types of things that a person is doing here. Would you say those are exercises, therapeutic activities? It depends on the intent of the task. For example, think of it this way. Doing abdominal curl simple abdominal curls can be used for strengthening weak abdominal muscles.

The person has low back pain. Their abdominals are very weak. Okay. I’ll say that is exercise. What if they’re doing it because this patient, because of their weak abdominal muscles, they literally cannot get themselves up from a lying down position. They have no strength there. So the abdominal curls are more designed to get them, to be able to raise themselves up from a lying down position that changes it to a functional.

So if you think of it functional activities, and we’re about give me something unique for this patient that you’re trying to have them complete certain tasks or tasks that best practice is determined is what the functional outcome that you’re expecting. Is it simply strength and flexibility or one with a functional outcome?

I would give an example. What if you had a person with carpal tunnel and you have them squeezing a ball because they have weakness in the flexor muscles. Okay. I’d say that’s. Now what about a person though, that they have a job where they have to lift items and grip them to pick them up. You’re now doing that same ball squeezing, but it’s because you want them to grip, to lift items that makes it the activity.

So think of it by design. That’s why it’s worth a little bit more differentiated. We know to think of the exercises, probably a path as I discussed, generally, exercise starts therapeutic activities finishes. I would assume because you’re trying to do something specific for the patient. It’s not a generic, one size fits all.

Everybody gets the same thing. I’m pretty sure you’re designed a little bit more. And for that reason, there’s a difference. In fact, Notice the relative values now, relative values are simply a number that tells you the value of one service compared to another. So by example, you’ll notice nights at 1, 1 0 has a 0.87 and 9 7 5 3 0 has 1.10.

So what does that telling us there’s about a 23% difference or let’s just round it to 25% difference between the two. In other words, if my fee for a 9 7 1 1 0 was 59. My fee for a 9 7 5 3 0 will be about 25% higher or about 12 to $15 more. Now to give you a relative term of it, look at the value of an adjustment of that.

An adjustment one, two regions is 0.81. So notice even exercises slightly more. Then the one to two region adjustment. Now a three to four region is a little bit higher, but you’ll notice here there should be a difference in price. Now you might think. How does this help me? My concern is sometimes offices, bill fees that make no sense.

So looking at this chart, if you’re saying your adjustment prices of $50, I’m just picking that fee up. What should be the value of 9 7100. Roughly about 6% more. No but probably 53 50 $4 comparative to notice the difference of 9 7 5 3 0. In fact, I would say 9 7 5 3 0 is about the value of a 99 41, which again is usually about the good 30% different.

So to give an example, let’s just take a look at Medicare rates. So this is a standard average Medicare rate for the three services. Notice 99 for about $30, but not as 1, 130. 9 7 5 3 0 41. So substantially more because it has a higher value. And if you think of it, doesn’t it make sense that a functional activity would have a higher value.

Think of the design, the purpose, a lot more goes into that. Exercises, give them a sheet of paper and follow them and make sure they’re doing it safely. But if they’re a quick activity is something that you’ve really taken the time to design that really focuses on your patient’s individual needs.

What I will say is I would bet, and I hope that you’re doing these services right. This is what really is going to get the patient to really resolve and rehabilitate, to not have it happen again, or at least minimize it, not just massaging it, which has to be a separate area, rehab focus here. And if you think of it, has anyone ever told you, man, I did 15 minutes of exercise and I’m in really good shape.

Probably. That’s why most physical therapists generally do no less than 45 minutes to an hour. And I’m not saying do that much, but what about two units? Would that be real? And most instances. Yes. And quite frankly, I just showed you, you’re going to get less pushback. So why are we fighting as a group for this passive care?

When in fact insurance companies prefer and what the act of care, which pays. Has better outcomes and less issues with separate areas. So start to think, how am I running my practice and how am I using the proper codes, but I’m certainly going to say rehabilitation. Now, this is something you can be part of this all the time.

We offer a service that call the network and I’ll say go our website, HJ Ross, look at our new section updates on chiropractic. Reducing healthcare costs. A really good article. What about the one lake standing? Are you incorporating that to your exam? Join to be part of our network, take a look at our site.

We can give you the full helpless seminars and more than just this, you can call an email, but with all questions, we want to be a resource to help you. ChiroSecure is always going to be your risk management. HJ. Ross is the place to go to make sure you’re getting paid in full. So I want to thank you all for being with me.

I will say next week’s house is going to be Mark Studin. So until a few weeks away, I’ll see you again. My friends take care.