Q: I have been hearing that I should be billing codes that are active care. Do you have examples of active-care codes?
A: Active care has become the "buzz" statement from insurance carriers who are taking this from the multitude of treatment guidelines commonly used to determine the efficacy of chiropractic treatment. Active refers to the style of care in which a patient is an "active" participant when the service is being performed. This is in contrast to passive care, which is care applied to the patient in which they have no active role.
Passive care would then be modalities such as heat, cold, traction, electrical stimulation, etc. Passive care also is useful in the early stages of care when the patient is exhibiting acute manifestations. Most passive-care modalities have very similar outcomes (reduction of pain, spasm and inflammation) and are therefore considered duplicative when multiple modalities are billed on the same visit. Note that massage might be considered passive, as it requires no activity from the patient and its purpose and outcome are similar and potentially redundant with other passive modalities.
Active care is therefore services that require patient participation. These would include: 97110 therapeutic exercise, 97112 neuromuscular re-education, 97530 therapeutic activities and 97150 group therapeutic activities. These styles of services often are referred to as "rehabilitation," as they specifically are designed and used to enhance "functional improvement." Functional improvement means either a clinically significant improvement in activities of daily living or a reduction in work restrictions. As such, it can be seen that active care is very "sports medicine" minded.
Therapeutic exercise 97110: The application of exercise as a method to improve tone, strength, flexibility and endurance, and facilitate healing. Active-care protocols are considered medically necessary for loss of joint motion, strength, functional capacity or mobility as a consequence from a specific disease or injury. Objectively, it should be demonstrated by loss of joint motion, strength or mobility. Specific exercises should be listed as to the type, method and goal. These could include stretching exercises, both static and facilitated. Specific exercises can be progressive resistance strength/endurance exercises such as isometric, isotonic and isokinetic. Long-term and short-term goals should be identified.
Neuromuscular re-education 97112: Provided to improve balance, coordination, kinesthetic sense, posture and proprioception. Be aware this therapy initially was designated for rehabilitation following stroke, surgery, fracture, etc., where the motor system needs to be "re-patterned" for normal activities. Also includes poor static or dynamic sitting/standing balance, loss of gross or fine motor coordination, and hypo/hypertonicity of soft tissue. There usually is a form of repeated active movements under a variety of mechanical conditions. Examples include proprioceptive neuromuscular facilitation, Janda, Feldenkrais, Bobath, Alexander, cross crawl, etc. Balance boards and similar equipment could be documented under this code.
Therapeutic activities 97530: This is a direct (one-on-one) procedure for the use of dynamic activities to improve functional performance. There must be direct contact by the doctor or therapist in a one on one setting. Dynamic activities would involve repetitive movement or activities such as bending, lifting, reaching, carrying, catching, overhead activities and/or transfers. A progressive protocol is most typical, increasing length and intensity of the activities.
Active care is, "pound for pound," the most advantageous source of physical medicine procedures (chiropractic manipulation excepted) and has proven to give the best long-term outcome versus passive services alone. Active care at its basic core is attempting to give the patient a fishing pole and not fish. Emphasize a sports-medicine model of rehabilitation and the care likely will be active in style.
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