Pitfalls and Concerns Over Roller Table Type Traction
Roller table type traction has been around for decades. Patients will tell you it feels great, and many doctors use it in practice. Variations on roller table traction include full massage chairs that can lay flat and stretch the patient, as well as hydrobed massagers. These massagers use water as the force to create the muscle relaxation and the desired effect. For years, the American Chiropractic Association’s position statement validated roller table type traction as “auto-traction,” which is the use of the body’s own weight for tractioning.
More and more, third-party payers have written medical review policy deeming roller table type traction as experimental, investigational, and unproven. However, because it is usually billed as 97012, Traction, the payer wouldn’t know that the service performed was roller table and would likely pay it. It’s up to the provider to be aware of these kinds of rules. Billing with a deceiving code could be dangerous.
In July 2020, the AMA’s CPT Assistant published a clarification that seems to refute the notion that auto traction is being performed with these devices.
Medicine: Physical Medicine and Rehabilitation July 2020 pages 13-14
Question: Can the use of a chiropractic roller table that is an adjustable device used to create a massaging effect along the spine be reported with code 97012.
Answer: No, the chiropractic roller table is a device that has adjustable mechanical rollers requiring stationary, supine positioning of a patient. The rollers can be adjusted for height and do not require constant one-on-one attendance with the patient to create a massaging effect along the spine. Tension via the adjustable rollers can create traction forces resulting in separation between vertebral joint surfaces. A review of the literature at the time of this printing does not support a roller table meeting the requirement of auto traction that requires the use of the body’s own weight to create sufficient force allowing for separation between joint surfaces, that may be reported with 97012, Application of a modality to 1 or more areas; traction, mechanical.
Therefore, code 97039, Unlisted modality (specify type and time if constant attendance), should be reported. When reporting an unlisted code to describe a procedure or service, submit supporting documentation (e.g., procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.
This doesn’t mean that a provider can’t use such a device in a self-pay fashion. Nor does it mean that certain payers wouldn’t pay for the service under 97039. Verification of this coverage and coding policy should be a precursor to submitting to any third-party payer. We suggest the office provide a form to patients outlining the fact that it is not a covered service and would be charged directly to them. Their signature indicates “opting in” to the service and recognition of the charges.
Sometimes, there is more to the story. Click here to read about a lawsuit regarding roller table traction in which the provider prevailed.