August 1, 2024 | Net Health

10 min read

Mastering CPT Code 97116 in Rehab Therapy

Mastering medical billing codes may not be the most glamorous part of working in rehab therapy, but it’s essential to ensuring your outpatient PT practice thrives.

Among the codes most prominent in physical and occupational therapy, CPT® code 97116 stands out. This code is your gateway to enabling a physical therapist to successfully bill for gait training therapy, an intervention that’s vital in working on patients’ walking abilities, balance, and coordination. Whether it’s utilized to help a patient recover from stroke, surgery, or an injury that impacts mobility, gait training is a lifeline on their journey toward regaining independence.

Correctly using code 97116 isn’t just about selecting the right number, however. It’s about making sure you deliver (and thoroughly document) the high-quality, personalized care your patients deserve without later facing financial or administrative roadblocks. When you master this code, you ensure patients get the full benefit of their therapy sessions while your practice secures the financial support it needs to thrive.

This article will explore best practices for correctly applying code 97116. We discuss when and how to use code 97116 to avoid claim denials and stay compliant, all while significantly boosting patients’ functional performance and independence.

What is CPT® Code 97116?

CPT® code 97116 is a time-based code for gait training, whether by a physical therapist or an occupational therapist. According to the American Medical Association, it is a “therapeutic procedure to one or more areas, each 15 minutes, gait training (includes stair climbing).”

This code is used in medical billing to describe a specific type of physical therapy that encompasses a range of activities aimed at enhancing walking efficiency, balance, and coordination, which are critical for patients who have impairments due to various medical conditions.

Definition and Description

Gait therapy involves the use of physical therapy exercises and techniques to help patients develop or restore their ability to walk with stability and confidence. This type of therapy often includes:

  • Teaching proper walking techniques
  • Assisting with balance and coordination exercises
  • Sit-to-stand training
  • Utilizing assistive devices such as canes, walkers, or crutches
  • Navigating different types of terrain and obstacles
  • Developing strategies to manage and improve walking endurance and strength

The primary goal of gait training is to help physical therapy patients achieve the highest possible level of independent walking, which can significantly enhance their quality of life.

Common Uses and Scenarios

CPT® code 97116 is commonly used when patients require rehabilitation to regain their walking abilities. Some typical situations include:

  • Post-Stroke Rehabilitation. Patients who have suffered a stroke often need gait training by an occupational or physical therapist to recover their ability to walk and manage balance issues.
  • Post-Surgical Recovery. Individuals recovering from surgeries, such as joint replacements or spinal operations, may require gait training to restore normal walking patterns.
  • Injury Rehabilitation. Patients recovering from significant injuries, such as fractures or severe sprains, benefit from gait training in physical therapy to regain strength and coordination.
  • Neurological Conditions. Those with neurological disorders, like Parkinson’s disease or multiple sclerosis, often need gait training to improve mobility and safety.
  • Developmental Delays. Children with developmental delays or disabilities may undergo gait training, sometimes by a pediatric physical therapy specialist, to enhance their walking abilities and overall motor skills.

Understanding and correctly utilizing code 97116 ensures that therapists can deliver effective gait training therapy, leading to better patient outcomes and streamlined billing processes.

Why is it Important to Correctly Apply CPT® Code 97116?

Correctly applying code 97116 is crucial for several reasons, impacting not only the financial and operational aspects of a physical therapy practice but also the quality of physical therapy patient care. Being accurate and thorough in its use helps in many areas.

Ensuring Proper Reimbursement

Accurate coding is essential for securing the appropriate reimbursement from insurance providers. When code 97116 is applied correctly, it helps ensure that the services provided are fully compensated. Incorrect or inconsistent use of this code can lead to claim denials or underpayments, which can significantly affect the financial stability of a physical therapy practice.

Maintaining Compliance

Compliance with insurance and regulatory requirements is critical to running a successful practice. Correctly using code 97116 helps physical therapists maintain compliance with these standards, reducing the risk of audits, penalties, or legal issues. Proper documentation and coding demonstrate a commitment to ethical billing practices and adherence to industry regulations.

Enhancing Patient Care

Accurate application of CPT® code 97116 directly contributes to the quality of patient care by physical therapists. By correctly documenting gait training therapy, therapists can create comprehensive treatment plans that are tailored to each patient’s needs. This ensures that patients receive the appropriate interventions to improve their walking abilities, which can lead to better functional outcomes and enhanced quality of life.

Streamlining Operations

Efficient billing practices streamline the administrative processes within physical therapy clinics. When CPT code 97116 is applied correctly, it minimizes the time spent on correcting errors or resubmitting claims. This efficiency allows therapists and administrative staff to focus more on patient care and less on paperwork.

Building Trust with Patients and Insurers

Consistent and accurate use of billing codes like 97116 helps build trust with both patients who receive therapy services and their insurers. Patients can feel confident that they are receiving the appropriate care for their condition, while insurers can trust that the therapy practice is billing for services accurately and ethically. This trust can lead to stronger relationships and a positive reputation in the healthcare community.

cpt code 97116

What Are Some Examples of Exercises and Treatments Under CPT® Code 97116?

Gait training therapy encompasses a wide range of exercises and treatments designed to improve a patient’s walking abilities, balance, and overall mobility. Here are some examples of physical therapy CPT® codes related to exercises and treatments commonly billed with code 97116.

Assistive Device Training

Rehab therapists help patients learn to use assistive devices such as canes, walkers, or crutches. This training ensures that they can use these tools effectively and safely to enhance their mobility and independence.

Balance and Coordination Exercises

These exercises are designed to improve a patient’s stability and coordination. Examples include standing on one leg, walking on uneven surfaces, and practicing weight-shifting activities. These exercises help patients develop better control and confidence in their movements. Depending on the movement, this can also be billed as neuromuscular re-education, code 97112, or therapeutic activities, code 97530.

Step Training

Step training involves practicing stepping techniques, such as stepping over obstacles, side-stepping, and walking up and down stairs. This type of training helps patients navigate various environments and improves their ability to handle everyday activities.

Treadmill Walking

Treadmill walking can be an integral part of gait training. It allows patients to practice walking in a controlled environment, where therapists can adjust the speed and incline—in some cases, high-tech treadmills may even enable therapists to adjust the patient’s weight—to match the patient’s abilities and progress.

Functional Walking Drills

These drills simulate real-life walking scenarios, such as walking while carrying objects, turning corners, and stopping and starting. These activities help patients apply their improved walking skills to daily life situations.

Gait Pattern Correction

Therapists work with patients to correct abnormal gait patterns. This may involve specific exercises to address issues such as dragging feet, uneven strides, or improper foot placement. Correcting these patterns helps improve walking efficiency and reduce the risk of falls.

Endurance Training

Building endurance is essential for patients to maintain their walking ability over longer distances and periods. Activities like prolonged walking sessions, both indoors and outdoors, help patients build stamina and improve their cardiovascular health.

Sensory Integration Activities

For patients with sensory deficits, integrating sensory activities can be beneficial. This might include walking on different textures, navigating through varied lighting conditions, or practicing walking with altered visual inputs.

Strengthening Exercises

While absolutely part of the process for gait training a patient, exercises that focus on strengthening the muscles involved in walking, such as the legs, hips, and core, are more likely to fall under code 97110, therapeutic exercise, which you can read more about below. Examples include leg lifts, squats, and resistance band exercises. Stronger muscles contribute to better support and control during walking.

Patient Education

Similarly, educating patients about proper body mechanics, posture, and safety techniques is an integral part of gait training, but is more commonly billed as code 97350, therapeutic activities. This education helps patients understand how to move safely and efficiently, reducing the risk of injury. It also helps ensure a patient’s exercise program is being followed properly and safely.

By incorporating these exercises and treatments into gait training therapy, therapists can create comprehensive and effective treatment plans tailored to each patient’s needs. Accurate application of CPT® code 97116 for these activities ensures proper billing, compliance, and, most importantly, optimal patient outcomes.

What Other CPT® Codes Are Commonly Used with 97116?

In rehab therapy, it is common to use multiple CPT® codes in conjunction with 97116, enabling rehab therapists to capture the full spectrum of services provided to patients. When used appropriately, these codes ensure comprehensive documentation and accurate billing for a variety of therapeutic interventions.

Some codes often used alongside 97116 include:

  • CPT® Code 97110 – Therapeutic Exercise. CPT Code 97110 is used for therapeutic activities and exercises aimed at improving strength, endurance, range of motion, and flexibility. It is often employed in conjunction with gait training to address the underlying physical deficits that impact a patient’s ability to walk effectively.
  • CPT® Code 97112 – Neuromuscular Re-education. This code covers physical therapy activities designed to improve balance, coordination, posture, and proprioception. Neuromuscular re-education is frequently combined with gait training to enhance the neural pathways and muscle responses necessary for improved walking patterns.
  • CPT® Code 97530 – Therapeutic Activities. CPT Code 97530 is used for dynamic activities that improve functional performance. These activities are tailored to simulate real-life tasks and can include training in activities of daily living (ADLs) and other functional tasks, which complement the goals of gait training therapy.
  • CPT® Code 97140 – Manual Therapy. Manual therapy techniques, billed under CPT Code 97140, include mobilization, manipulation, and manual lymphatic drainage. These techniques can be used to address soft tissue restrictions and joint dysfunctions that may affect a patient’s gait and overall mobility.
  • CPT® Code 97542 – Wheelchair Management. For patients who use wheelchairs, CPT Code 97542 covers the assessment and training for wheelchair mobility and management. This code may be used alongside gait training to ensure that patients have the necessary skills to use their wheelchairs effectively while also working on improving their walking abilities.
  • CPT® Code 97760 – Orthotic Management and Training. This code involves the fitting and training in the use of orthotic devices. For patients who require braces or other orthotic supports to aid in walking, orthotic management is an essential complement to gait training therapy.
  • CPT® Code 97761 – Prosthetic Training. This code is used for billing services related to the fitting and training in the use of prosthetic devices. This code covers the time spent by a therapist in instructing the patient on how to properly use, adjust, and care for their prosthetic limb to enhance functionality and mobility.
  • CPT® Code 97750 – Physical Performance Test or Measurement. CPT Code 97750 is used for standardized tests and measurements to assess a patient’s functional capacity. These assessments are often conducted before, during, and after gait training to objectively measure progress and outcomes.
  • CPT® Code 97535 – Self-Care/Home Management Training. This code covers training for self-care and home management activities. Therapists may use this code alongside gait training to teach patients how to safely navigate their homes, perform personal care tasks, and manage their daily routines independently.
  • CPT® Code 97545 – Work Hardening/Conditioning. For patients preparing to return to work, CPT Code 97545 covers comprehensive work hardening or conditioning programs. These programs often include gait training components to ensure that patients can handle the physical demands of their jobs.
  • CPT® Code 97113 – Aquatic Therapy. Aquatic therapy, billed under CPT Code 97113, involves physical therapy services and exercises performed in water. This low-impact environment can be particularly beneficial for patients undergoing gait training, as it reduces stress on the joints and allows for greater ease of movement.

CPT Code 97116 for Gait Training Explained

Mastering the use of CPT® Code 97116 for gait training therapy is a vital skill for therapists and billing professionals in the fields of physical therapy and occupational therapy. This code not only ensures proper reimbursement and compliance but also plays a crucial role in delivering high-quality, individualized patient care.

Gait training is a pathway to improving patients’ lives. From enhancing mobility and reducing fall risks to boosting psychological well-being and facilitating a return to normalcy, the benefits of effective gait training are profound. By correctly applying CPT Code 97116 and its complementary codes, therapists can help patients regain their independence and perform everyday activities with greater ease and confidence.

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