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CPT code 97112 denied for treatment of ICD-9 code 825.25

Clarence Posted Fri 21st of January, 2011 21:06:55 PM

Insurer has denied billing for code '97112' in treatment of diagnosis code '825.25' stating "Claim or charges denied because procedure/treatment is deemed experimental" Any suggestions on how to appeal this determination or a better cpt code to use. The Therapist maintains that Neuromuscular Re-Education which includes: balance, proprioception, coordination, & kinesthetic is appropriate for rehabilitation of a 3rd metatarsal head fracture (dx code 825.25)

Carmen Answered Sat 22nd of January, 2011 08:29:25 AM

Use cpt-97110 it will pay out, anything to do with exercise will. Do not focus on the re-education. That fact is
the therapist is giving therapy. It will not pay more for re-education believe me. Good Luck

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