2010 Billing Codes and Suggestions

2010 Top Suggested Billing Code:

97112 - Neuro-Muscular Re-Education (this code can apply to any taping option)
Neuro-Muscular Re-Education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities, 1 or more areas, each 15 minutes.
RVU 2010 CodeBook: ncci .83
RVU data includes: work time, 18 min. / supplies, $1.75

Other Therapeutic Procedure codes that may be appropriate:

97110 - Therapeutic Procedure/Exercise one or more areas
RVU 2010 CodeBook: ncci .79
RVU data includes: work time, 18 min. / supplies, $1.75

97116 - Gait Training
RVU 2010 CodeBook: ncci .70
RVU data includes: work time, 15 min. / supplies, $1.18

97139 - Unlisted Therapeutic Procedure
RVU 2010 CodeBook: ncci .42

97140 - Manual Therapy Techniques
RVU 2010 CodeBook: ncci .74
RVU data includes: work time, 15 min. / supplies, $1.30

97533 - Sensory Integrative Techniques to enhance sensor processing and promote adaptive responses to environmental demands
RVU 2010 CodeBook: ncci .74
RVU data includes: work time, 23 min. / supplies, $2.18

97799 - Unlisted Physical Medicine/Rehabilitation service or procedure
RVU 2010 CodeBook: ncci .NE

Body Regions (by CPT) Are:

Head	Lower Extremities
Cervical	Upper Extremities
Thoracic	Rib Cage
Lumbar	Abdomen
Sacral	Viscera
Pelvic

Strapping Codes: The following definition comes directly from the 2010 ChiroCode DeskBook. Some insurance carriers are denying use of strapping codes saying this is a surgical procedure code. However, these codes have been in use successfully for the past 10 years and as you will read in the definition below, the term surgical is not used.

Casts, Straping and Taping:
These codes are for use when a cast application, strapping, or taping is used to stabilize or protect a fracture of dislocation, or to afford a patient comfort. This can be performed as an initial treatment or as a replacement service during or after follow-up care.

Use these codes in the following situations:

• When the initial encounter involves treatment of the injury, use the codes in this section.
• When the encounter follows initial treatment performed by a different practitioner, you may still use the codes in this section.

However, do not use these codes in the following situations:

• When the initial encounter involves only strapping or casting without treatment (e.g., a sprained ankle), use the appropriate E/M and supply codes.
• When taping is used for dynamic extension, not immobilization, use the appropriate E/M ad supply codes.

Note: When there is orthotic or prosthetic management and training, see codes 97760 - 97762. These codes are often overlooked when performed in an office. From a CPT coding perspective they could be used for any of the following reasons.

• Afford comfort to the patient.
• Provide initial service without restorative treatment.
• Replacement during or after follow-up care.
• Stabilize or protect fracture, injury, or dislocation.

Strapping Codes 2010:	RVU 2010 CodeBook:
29200 - Thorax	ncci 1.35
29240 - Shoulder (eg, Velpeau)	ncci 1.47
29260 - Elbow or Wrist	ncci 1.30
29280 - Hand or Finger	ncci 1.26
29520 - Hip	ncci 1.25
29530 - Knee	ncci 1.32
29540 - Ankle and/or Foot	ncci 1.07
29550 - Toes	ncci 1.04

Note: 29220 (Strapping of Lumbar Spine) has been eliminated from the code books.

Level 1 CPT Modifier Examples:

-22	Unusual procedural services
-25	Significant, separately identifiable evaluation and management service the same physician on the same day of a procedure or other service
-26	Professional Component
-32	Mandated Services
-50	Bilateral Procedure
-51	Multiple Procedures
-59	Distinct procedural service
-76	Repeat procedure by same physician
-77	Repeat procedure by another physician
-99	Multiple modifiers

It has been determined that the modifier 56 may not be applicable.

Suggestion from Therapists:

1. For Medicare, if taping bilateral use code for first and modifier for second. Cannot use shoulder bilaterally. For many insurances need to use 51 modifier. These are non-timed codes, so use in addition to other timed codes (ther ex, gait training, etc.)
2. 29799 (Unlisted Casting & Strapping) to bill for the Kinesio Taping - lumbar, it is important to include a written explanation to avoid the "knee-jerk" denial due to lack of sufficient info. The office typically does the same thing when billing for unlisted medical supplies and equipment.

HCPCS 2010 Reimbursement Code Options
Level 1 - CPT Numeric Codes 29529-29550 and 29200-29280 (Same as CPT codes.)
Level 2 - CMS Alpha-numeric Codes

99070 - Supplies (This general CPT Code for any supply could be used by some payers in lieu of the specific HCPCS and ABC codes.)
A9270 - Non-covered item or service (CMS Fee Ceiling = $NE)
A9900 - Miscellaneous DME supply or accessory, not otherwise specified. (CMS Fee Ceiling = $NE)

Tape:
A4450 - Non-waterproof, per 18 square inches (CMS Fee Ceiling = $.12)
A4452 - Waterproof, per 18 square inches (CMS Fee Ceiling = $.42)

Light Compression Bandage:
A4466 - Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each. (CMS Fee Ceiling = $NE)
A6448 - Elastic, knitted/woven, width less than three inches per yard (CMS Fee Ceiling = $1.22)
A6449 - Elastic, knitted/woven, width greater than or equal to three inches and less than five inches per yard. (CMS Fee Ceiling = $1.84)
A6450 - Elastic, knitted/woven, width greater than or equal to five inches per yard. (CMS Fee Ceiling = $NE)

ABC Code Example: EAABT (Taping Supplies)

Level II Supply Modifier Examples:

-BP	The beneficiary has been informed of the purchase and rental options and has elected to purchase the item.
-NU	New Equipment
-LT	Left Side (used to identify procedures performed on the left side of the body)
-RT	Right Side (used to identify procedures performed on the right side of the body)
-SC	Medically necessary service or supply
-SU	Procedure performed in physician's office (to denote use of facility and equipment)
-TC	Technical Component

Denials
Why you should appeal: Reimbursement revenue is what keeps you in business. The typical practice loses thousands of dollars in reimbursements that are denied or paid at an unreasonably low level. Unpaid claims can be a challenge and an opportunity for every practice and practitioner. It is not uncommon to have to "do battle" with the payers.
Most practitioners ignore the most effective action they can take for obtaining payment on a denied claim: filing an appeal. According to statistics, only a small percentage of offices appeal their insurance denials-either because they don't know how, they lack the time, or they are fearful of retaliation. Regretfully, many write-off the loss as a cost of doing business rather then make the effort to collect fees that are rightfully and legally due.
According to the 18th Annual Edition of the 2010 ChiroCode DeskBook from the ChiroCode Institute, a practitioner needs to take these steps when filing an appeal.

1. Review of payment Reports
2. Review your contract
3. Ask Questions and control your temper
4. Register Complaints: Send a written complaint to the director of provider relations. Always "cool off" before sending the letter. Read through it when you are calm, to ensure that the tone of the letter is professional and factual, not personal.
5. Contact Agencies working on your behalf: The following are some suggested groups that may be willing to help with unresolved issues. Understand who the key players are in your state, as they may be able to point you in the direction that could help the most. If all else fails, try one or all of the following.
   • Local Associations
   • National Associations
   • State Insurance Commissioner
   • State Attorney General
   • Consumer Advocacy Groups
   • Media
   • Congressional Representatives
6. Stay informed
7. Keep your patients informed

Use Appeals To Your Advantage:
The more you appeal your denied claims the less likely they are to deny them in the future for bogus reasons. Most practices think they are the ones who made the mistake when they get a denial from a carrier, and so they do not appeal because they believe they will get more denials. That is just not the case.

Steps To Reduce Denials:
If third-party payers are going to randomly deny bills just for fun and because they know you won't fight back, what can you do to reduce denials when billing to insurance carriers?

1. Make sure you are using the most current versions of the CPT, ICD-9, and HCPCS.
2. Ensure the proper usage of modifiers on your claims where appropriate. Many codes require that modifiers be used.
3. Utilize the National Correct Coding Initiative (NCCI) in your defense. If you are up to standard as far as the NCCI goes, use it when appealing denials and defending your billing.
4. Use the internet to search for policies from the various carriers. Many post policies online.
5. For those payers with a formal appeals process such as the federal and state programs, know your appeal rights and the various steps involved with the process.

For example letters and appeal forms please visit www.chirocode.com/2010deskbook.

All information regarding billing and claims courtesy of the 18th Annual Edition of the 2010 ChiroCode Deskbook from the ChiroCode Institure.