Q&As Galore!
Q: We have an intersegmental traction table and I was thinking about getting some massage chairs for the same effect but to save space, can you bill a massage chair as intersegmental traction?
Thanks!
A: If you are talking about a massage chair that lays flat, and has roller technology to work like a roller table, it would likely meet the requirement. The rules for intersegmental traction are specific, and the only way even a Spinalator table meets the requirement is as auto-traction: use of the body’s own weight to create the traction. So if the chair can lay flat, and meet the requirement that should work. Don’t forget to make sure you have that clearly laid out in your treatment plan, exactly how many, for how long, and for what goal.
Here is some information shared by the ACA about 97012:
97012 – Traction; Mechanical
Application of a Modality to One or More Areas; Traction; Mechanical
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction are intermittent or static (describing the length of time traction is applied), or auto-traction (use of the body’s own weight to create the force).
Mechanical Traction is a supervised modality. A supervised modality is the application of a modality that does not require direct (one-on-one) patient contact by the provider.
NOTE: Supervised modalities may be reported only ONCE per patient encounter.
Coding Clarification: 97012, Mechanical Traction:
http://www.acatoday.org/content_css.cfm?CID=1135
Coding Clarification for Spinal Decompression:
http://www.acatoday.org/content_css.cfm?CID=1135
Use of Physical Medicine Modalities by Doctors of Chiropractic Coding Clarification:
http://www.acatoday.org/content_css.cfm?CID=1157
Q: If I am using a motorized type of traction device what code should I use?
A: CPT Code 97012, mechanical traction, should be reported when performing traction with a motorized traction device.
Q:Are there different types of family/individual deductible arrangements? I thought that all eligible expenses went toward both the individual deductible and family deductible simultaneously until either one or the other was met and then benefits would be paid but I think I found at least one exception to that rule.
A: Interesting question. My own insurance is one of those exceptions. I have an HSA (Health Savings Account) and I’m the insured, with my husband and son as dependents. It clearly lists the deductible as $3000/individual and $6000/family. Imagine my surprise last year, when I met my $3000 and expected additional services to be paid, that they weren’t! That’s because if it’s an individual plan, then it’s $3K. If it’s family, the full $6K has to be met, and can be met by any combination of services from any of the three of us. So we effectively have a $6K deductible.
It’s one of the most important questions you can ask as you are verifying insurance, if there is a family deductible. Ask like this: “I see that you have a family deductible. If an individual deductible is met by one, will that person now have benefits, or must the entire family deductible be met before anything is paid?”
Q: I have a patient who I have been treating off and on for a few years. Recently he was hit (punched) by one of the caregivers who had been taking care of his significant other. My patient has Medicare. Should I bill Medicare? What do I do from there? Do I bill from my regular fee schedule?
You have a complicated situation here. If he was punched by a caregiver, is there intention of “suing” the caregiver or the company? I do not understand the context of why the guy was punched, but you are correct to question whether Medicare would be primary. The moment the notes say this was because of a third party action, Medicare will immediately become secondary. If there is nobody else to sue, or to expect payment from, then you would bill Medicare as per usual, with a new condition date in Box 14 of the 1500 billing form, and start a new episode of care relative to this incident. I would think you have no problem calling this Acute treatment.
If there is intention to sue or bring a third party action, you will want to review all the rules of Medicare as a Secondary payer which can be found here: https://www.cms.gov/manuals/downloads/msp105c02.pdf
