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billing for 97012

Donna Posted Thu 07th of June, 2012 15:41:04 PM

Can more than one unit of traction, 97012, be billed each day?

SuperCoder Answered Thu 07th of June, 2012 15:48:26 PM

Mechanical traction normally lasts from 15 to 30 minutes, and most policies allow payment of 97012 for up to four sessions per week for one month. Any treatment continuing past this time usually requires documentation supporting the medical necessity, unless mechanical traction is the only way a patient can adequately perform other therapies. For instance, if a patient has too much back pain to perform her therapeutic exercises, the therapist may administer mechanical traction to ease pain, so the patient can more comfortably do the exercises. In this case, bill both 97012 and 97110 (therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility).

In addition to the herniated disk codes (722.0-722.2), most carriers reimburse for 97012 with diagnoses for neck pain (723.1), torticollis (723.5), lumbar stenosis (724.02), low back pain (724.2), sciatica (724.3) and neck sprain (847.0), among other conditions. However, more conservative carriers, such as Florida Medicare, will reimburse for 97012 only if the patient has cervical or lumbar radiculopathy. You should get a copy of your carrier's policy in writing before coding for these services.

There are no CCI edits that preclude coders from billing 97012 along with a physiatrist's E/M code or a physical therapist's evaluation, so modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should not be necessary for these claims.

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