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BILLING

Aida Posted Mon 19th of August, 2013 12:52:18 PM

I am looking for billing codes, instead of billing this codes (physical therapy) 97530, 97112, 97032 which would require the face to face interaction with therapist.

The neurologist I am working for is doing this procedure without the therapist and not a face to face. what other codes can I use instead. I only found the S9090. My payor do not pay for this procedure code.

I am looking to other codes for 97110, 97112, 97032, 97750, all of this codes require the face to face interaction.

Please advise,

Thanks

SuperCoder Answered Mon 19th of August, 2013 20:17:45 PM

According to the November 2004 CPT Assistant article “Vertebral Axial Decompression Therapy,” you should use 97012 (Application of a modality; traction, mechanical) in this situation. The article states, “code 97012 would be the most appropriate code to report for the various types of mechanical traction devices (e.g., computerized/ motorized) including vertebral axial depression.”

You may also use HCPCS code S9090 (Vertebral axial decompression, per session) for some payers.

Some coders elect to use the unlisted-modality code, 97039 (Unlisted modality [specify type and time if constant attendance]) to eliminate any potential misrepresentation of services, as well as payers processing and reimbursing for non-covered services. On the other hand, some providers elect to have these services on a patient cash-pay basis.

Before your provider purchases this machine, you should point out that many payers have a noncoverage policy regarding this service. CMS has a National Coverage Determination of noncoverage.

Likewise Aetna, Cigna, Oxford, Wellpoint and the BCBS Associations have similar noncovered or investigational services policies for this type of noninvasive decompression. Best tactic: Check with your top payers regarding coverage before purchasing or leasing these types of machines.

What it is: The DRX9000 is one of the many “computerized tables” on the market that provide an alternative noninvasive, nonsurgical procedure for applying traction to the spine. Typically, these types of machines are fully automated, computerized systems with a split-table design.

The patient lies face down, and some type of restraint mechanism (either shoulder or handgrips) restrains movement of the upper body, which is supported on the fixed section of the table. The moveable portion of the table, which supports the lower body, slowly extends, applying a distraction force to the lower spinal area.

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