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heat/ice pack home use HCPCS Code

Pauline Posted Thu 15th of November, 2012 19:49:46 PM

Do you know any hcpcs code for heat/ice pack for home use in 2012?

SuperCoder Answered Fri 16th of November, 2012 05:21:06 AM

The code definition for 97010 states, "application of a modality to one or more areas; hot or cold packs." Because the definition includes both hot and cold packs to one or more regions, it should be billed only once per visit, regardless of the time involved or the temperature of the packs applied. This therapy does not require direct one-on-one patient contact by the provider.

Although hot packs and ice packs have a HCPCS designation under Part B, the reimbursement for these codes is $0 as Medicare has "bundled" their use with other reimbursed codes such as therapeutic exercise.

Thus, these thermal agents are provided in conjunction with other reimbursed codes, both supervised and direct. Only the supervised and direct modalities or procedures are reimbursable under Part B.

For example, a patient may be set up on unattended electrical stimulation and have a hot pack applied at the same time; the patient is charged one unit for the electrical stimulation. A patient may be receiving therapeutic exercise to the lower limb while having a hot pack to the back; the patient is billed for the time receiving the therapeutic exercise, not the hot pack. If the exercise is completed and the patient spends another five minutes on the hot pack, that time cannot be included, as the direct one-on-one time has finished.

The Part A regulation governing the time that can be entered into the MDS is found under Section J in the Final Rule for SNF PPS noted in the reference below.

This states: the beneficiary's "therapy time starts when he begins the first treatment activity or task and ends when he finishes with the last apparatus and the treatment is ended." Set-up time is included, as is time under the therapist's or therapy assistant's direct supervision.

For example, if the patient has been receiving exercise for a knee replacement, followed by an ice pack to help reduce pain/inflammation prior to performing gait training activities, then this is included as part of the total treatment time. The therapist would be monitoring the ice pack and the patient's response before determining the appropriateness of starting the next activity. If this occurs during an assessment period then those minutes can be included in the MDS.

With regard to the Minnesota case mix system, if it follows Medicare Part A regulations for counting minutes, the time for hot/cold packs counts in the total time the patient is receiving therapy.

A9273 is the HCPCS.

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