Coding Questions: How to bill and code for spinal decompression therapyPublished: 2010-07-06 22:06:20Author: Marty Kotlar | ChiroEco | March 2010
Q: I own a spinal decompression therapy table.
Most of my patients have insurance and want me to submit the claim to
their carrier, but I am hesitant to do this. What is the most
appropriate way to submit the claim?
A: Just about everyday this question gets asked and it’s a simple
question, but there's no simple answer.
"Just use
the 'traction' code" was the common thought, but when the topic of
insurance reimbursement and spinal decompression therapy was researched,
it was found that the traction CPT code of 97012 is not acceptable by
most Medicare carriers. Some Medicare carriers recommend CPT code 97799
and some require 97039.
Although Medicare does
not consider certain spinal decompression therapies to be a payable
service, some Medicare patients request or demand you bill for denial
purposes. HCPCS code S9090 is another procedure code that some carriers
may require for payment or to provide notification of patient financial
liability.
Two goals
If
you collect cash from your patients for spinal decompression therapy,
you should have two goals in mind from a coding and patient
reimbursement aspect:
1. Try to get the insurance
company to reimburse the patient directly, or
2. Try to get
the insurance company EOB to state "patient responsibility."
If
you submit the wrong code, incorrect modifier, or do not have the
patient sign the proper advanced notice of payment forms, you may have
to return the money to the patient or insurance carrier.
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