Taylor Posted Tue 02nd of January, 2018 16:46:27 PM
We are an Orthopedic Office and have begun using low level laser treatment on some of our patients. We have been billing CPT code S8948. So far we have only gotten a couple of these paid with this code and the remainder denied even after submitting medical records for review. When following up with the carrier on those that paid, we were told that this code is typically nor a covered service for Orthopedic ailments and those that were paid were paid in error. It looks that some offices have used ICD10 97026 and 97039 in place of the S8948,but the reimbursement is low.
Has anyone gotten S8948 paid for orthopedic issues and/or is these another code you would suggest that is more likely to get paid? Thank you
SuperCoder Answered Wed 03rd of January, 2018 03:24:35 AM
HCPCS code S8948, covers the services of a provider who remains in attendance while a patient receives low level laser therapy, or LLLT, a form of phototherapy, the use of variable wavelength light, typically to treat skin diseases, depression, orthopaedic conditions or seasonal affective disorder. Report this code for LLLT delivered with a provider in attendance at all times. LLLT of a correct wavelength and intensity improves the oxygen level in cells, which increases cell metabolism and energy output.
This mechanism helps wounds heal faster, reduces acute and chronic pain, and improves inflammation. Use this code for each 15 minutes of LLLT application in the presence of a provider.
For Medicare, it would likely need to be CPT 97039 (Unlisted modality [specify type and time if constant attendance]). You should submit adequate documentation in support of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service.
According to the CPT® guidelines, you should not choose a code that merely approximates the service provided. You should report the service using only the appropriate unlisted procedure code if no such specific procedure or service code exists, as it is appropriate to use CPT 97039 for LLLT.
CPT 97026 is for infrared treatment, which is not appropriate for LLLT.