Coding Questions: Spinal decompression therapy

Published: 2009-07-21 12:09:22
Author: Marty Kotlar | Chiropractic Economics | December, 2008

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.

EOBs that state “patient may not be billed for this service” or “patient not responsible” or “provider responsibility” are not ones you want to see. You work hard for your money and do not want a patient to ask you for a refund because of an insurance carrier EOB.

One action step to take is to call the carrier and ask what their position is on spinal decompression therapy. If you are “in-network,” you must follow their guidelines and they may have limitations on what financial responsibilities the patient has and how to submit the claims. Out-of-network providers may also have restrictions and may need to follow certain claim submission guidelines.

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