Physical Medicine & Rehab Coding Alert

How to Avoid Common Mistakes When Billing For Water Modalities and Fluidotherapy


- Published on Sun, Apr 01, 2001
Although physiatrists and therapists embrace the virtues of water modalities such as whirlpool (CPT 97022 , application of a modality to one or more areas; whirlpool) and Hubbard tank (97036, application of a modality to one or more areas; Hubbard tank, each 15 minutes), many practices still confuse the codes for these procedures, setting themselves up for denials and low reimbursement rates. The following list of commonly made errors and solutions will help these practices more accurately submit claims for proper payment of these therapeutic modalities.

Error #1: Billing 97022 and 97036 When Used for the Same Condition

A patient with osteoarthrosis of the ankle and foot presents for her weekly therapy session, at which she complains of more pain than normal in her ankle. The therapist places the patients foot in a whirlpool for 15 minutes and leaves the room. When the therapist returns, the patient has removed her foot from the whirlpool, stating that the angle at which she must hold her leg to keep her foot in the whirlpool has given her a cramp. The therapist immerses the patient completely in a Hubbard tank for 30 minutes, so the foot and ankle can receive more even coverage.

The therapist bills for the whirlpool using one unit of 97022 and for the Hubbard tank using two units of 97036. The claim for the Hubbard tank is rejected by the insurer, with a notation stating that it is not medically necessary to have more than one form of hydrotherapy during a visit.

Most carriers will not allow therapists to bill for both a whirlpool and a Hubbard tank for the same condition on the same date, says Paula Kingston, billing manager at Raleigh Physical Therapy, a two-therapist practice in Raleigh, N.C. The therapist has to look at the situation ahead of time and choose one. They can bill for only that modality.

The scenario above would be billed using two units of the 97036 code for the Hubbard tank, along with the ICD-9 code for osteoarthrosis of the ankle, 715.17.

If the therapist performed both modalities together, then found out after the fact that only one was payable, he or she should bill for the modality that lasted the longest amount of time in this case, the Hubbard tank. In addition, the Hubbard tank offers a higher reimbursement rate because it requires constant attendance, whereas the whirlpool is a supervised modality (so the patient can be set up with the whirlpool and then left unattended for a period of time.)

The Hubbard tank is more involved because sometimes it requires the therapist to use a lift to get a patient from a wheelchair into the tank, says Laureen Jandroep, OTR, [...]

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