When communicating with 3rd party payers, it is most effective to request preapproval for Evaluation & Treatment (ex. Occupational Therapy Evaluation and Treatment) rather than to request “Interactive Metronome” because it is a modality that they are unfamiliar with because it does not have an assigned CPT code.
The following remarks were shared with us re: billing practices from Occupational Therapist, Physical Therapist and Speech & Language Pathologist IM providers:
I bill for IM as a modality and not the sole component of the session is therapeutic exercise or neuromuscular technique. I have been billing for my IM time without any difficulty…
The 97110 code states:
97110 THERAPEUTIC EXERCISE (EACH 15 MIN.) Used when performing therapeutic exercises to develop strength and endurance, range of motion and flexibility to one or more areas each 15 minutes. One-on-one interaction with patient. (Example: Use this charge when performing initial ACL quad vmo and ROM exercises, or performing Lumbar Stabilization and the goal is strengthening muscles.)
I believe IM affects: “Used when performing therapeutic exercises to develop strength and endurance, range of motion and flexibility to one or more areas each 15 minutes.”
97112 NEUROMUSCULAR RE-EDUCATION (EACH 15 MIN.) Used when performing neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and proprioception.
The same applies to 97112… IM works on “balance, coordination, kinesthetic sense, posture and proprioception” …..
To bill Medicare you have to relate the use on a skill or technology to the functional goals of the patient…. climb stairs effectively, feed himself or walk to the bathroom without falling… and so on.
Medical necessity must be established and functional goals created to justify the treatment. -Dillen Hartley, OTR/L
We bill Medicare for our adults, Medicaid for pediatric (Medicaid does not cover Occupational Therapist for adults). We typically bill for neuromuscular re-ed which covers coord – 2 units, and therapeutic procedure for endurance – 1 unit. It is my understanding that Medicare will not cover 3 units of one of those modalities alone. We have been billing insurance for IM since we started in 2001 or 2002 and never had any problems. We keep a flow sheet in the chart that we designed just for IM. In the body of the note we may say that the patient is working on timing, coordination, endurance… And to refer to the flow sheet. – Linda
SPEECH AND LANGUAGE PATHOLOGIST
We’ve been using IM at HSRH for years and as far as I know have had no insurance denials. I believe the reason is because we use CPT codes that are appropriate to the goals that we have set aside for our patients as related to their ICD-9 codes. –Dara Coburn CCC-MSP
Several therapists at Idaho Elks Rehab bill Medicare & Medicaid and discuss IM in their treatment notes. No problems with reimbursement. The notes typically refer to IM in context to the treatment objective. For example, “patient performed coordination exercises using Interactive Metronome in seated and standing with emphasis on crossing midline and anterior weight shifting.” The specific exercises are often linked to something functional such as transfers or gait. – Shelley Thomas, MPT