The term "aquatic therapy" is a very different kind of therapeutic procedure "term" than all others in the 97000 series. Why? Because it describes an environment, and not an intervention.

Case in point. We can do gait training in the water -- but if we code it using 97113, there is no way to distinguish it from doing manual therapy (or therapeutic exercise or neuromuscular re-education or massage) in the water.

The payer knows where the action took place, but not "what kind" of action it was. I believe, this is the crux of the problem that insurers are having with the 97113 code.

By making aquatic therapy a unique code, we have made it seem as if aquatic-based interventions are unique (insurers read it: "experimental") procedures, instead of the same old procedures taking place in an aquatic medium.

On one hand, I am glad that there is an acknowledgement that therapy can take place in the water. But I think we've created a monster. In 1995, the AMA defined "aquatic therapy" (97113) as a new code in order to tease it out as different treatment from whirlpool or Hubbard tank (passive modality) treatments.

I now wish we did not have the 97113 code for this reason: It clouds the mind of the payer. They think that "aquatic therapy" is something different than therapeutic exercise, or gait training, or manaual therapy, or functional task training in water. They think it is a new (untested) thing.

What the AMA should have done (in my opinion) was limit the use of the whirlpool codes to therapists who were performing wound care, and then continued to use all the other CPT codes to define the procedure performed (e.g. therapeutic exercise, gait training) -- whether that procedure was performed on land or in the pool.

We don't have a separate code for mat-based therapy or plinth-based therapy, why a separate code for pool-based therapy? It does not describe the intervention that is taking place, but only the medium in which it occurs.

I would argue that we should return to the use of the old standard CPT series (97110, 97112, 97124, 97149, etc.) to describe all PM&R -- regardless of environment. But, I'm afraid that may be impossible for the following reasons.

1. Payers may take that as an indication that the AMA has "changed their mind" about aquatic therapy being a valid therapeutic procedure. Payers may begin to deny payments once they realize where the therapy took place (Note: this would not happen at the coding stage, since the code would no longer show environment. Instead, this would happen if payers requested follow-up documention).

2. Clinicians are now being reimbursed at a higher rate for the code aquatic therapy, than all other 97000 codes, except evaluation and reevaluation. The "relative value" assigned to aquatic therapy is high, because of the nature of the care: it requires more malpractice insurance, it requires more physical environment expense, and it requires more skill and time as a provider to perform.

If we delete the code 97113, and return to using the old favorites, we lose the financial acknowledgement of the expenses involved in performing aquatic therapy. Well, it's interesting to think about anyway.

Disclaimer
The information presented in this article is meant to be a summary and educational in nature. It is not meant to serve as a substitute for legal advice.

Author Bio
Andrea Poteat Salzman, MS, PT is the owner of two businesses, the Aquatic Resources Network and Concepts in Physical Therapy. She has received both the prestiguous Aquatic Therapy Professional of the Year Award (Aquatic Therapy and Rehabilitation Institute) and the Tsunami Aquatic Therapy Award.

Salzman is well-regarded within the industry as:

• Editor-in-Chief of an aquatic therapy trade journal and newsletter;
• Author of over a dozen publications, including the soon-to-be-released Evidence-Based Aquatic Therapy textbook;
• Freelance author and columnist;
• Aquatic therapy seminar instructor;
• Adjunct faculty and research advisor, St. Catherine Physical Therapy Program, Minneapolis, MN;
• Immediate past manager of therapeutic aquatics, St. Paul Ramsey Medical Center, St. Paul, MN;
• Researcher and grant recipient examining aquatic exercise vs. land-based exercise.

She may be reached via e-mail at asalzman@aquaticnet.com