Coding FAQ - General

Q: When working with a Medicare patient, what modifier should we use for services other then Spinal Manipulation? We were using GY...is this correct?

A: Yes. The GY modifier is used for all statutorily non-covered services, and covers everything other than CMT.

Q: Can I get paid when I strap or tape an extremity?

A: Of course you can. It’s a separately identifiable service from the others performed in a visit. There are specific codes for each one. Remember, if you have agreed to specific fee schedules and allowances by joining your patient’s managed care group, you may not have the ability to bill or be paid separately for these services.

Q: Why are my billings for CPT 97020 being denied?
A: In the physical medicine section of CPT, for calendar year 2006, CPT code 97020 has been deleted. The reason for deletion is due to infrequent use.  Microwave therapy is a form of diathermy, a way of generating heat within an area of the body for thrapeutic purposes.  Therefore, CPT97024, Application of a modality to one or more areas; diathermy, has been revised with additional languatge in parentheses to note, "eg: microwave"

Q: When billing for E/M and CMT on the same date of service, do I need to append the -25 modifier to the E/M code? 
A: Yes.  When billing a separate E/M code with CMT you are indicating that you have gone above and beyond the usual pre-service and post-service work associated with the CMT and a-25 modifier must be reposrted in order to indicate that you have done so.

Q:  Can I get paid when I strap or tape an extremity?
A:  Of course you can. It’s a separately identifiable service from the others performed in a visit. There are specific codes for each one. Remember, if you have agreed to specific fee schedules and allowances by joining your patient’s managed care group, you may not have the ability to bill or be paid separately for these services.

Q:  How does the CPT book describe strapping and taping?
A:  Because the strapping and taping codes mirror the casting codes, much of the description concerns fractures, injuries and/or dislocations. The latest version of Common Procedural Terminology (CPT) states that:

"The listed procedures only apply when the cast application or strapping is a replacement procedure used during or after the period of follow up care, or when the cast application or strapping is an initial service preformed without a restorative treatment or procedure to stabilizer or protect a fracture, injury, or dislocation and/or to afford comfort to the patient."

Therefore, the best way to report the strapping/taping performed in your office would be the strapping CPT codes. 

Q:  What are the standard codes for strapping extremities?
A:  The following are codes for the most common joints:

Elbow or Wrist:  29260
Shoulder:  29240
Hand or Finger:  29280
Knee:   29530
Ankle/Foot:  29540

Q: Can I bill for the time when I take the strapping off the patient on a subsequent visit?
A:  No, the removal is built into the cost of applying the strapping.

Q:  How do we know the reimbursement amounts for these codes?
A:  Because reimbursement rates vary from state to state, based on geographic region, it’s best to use the average national relative values published by a group such as Ingenix.  This is a good ball park amount between the 50th and 75th percentiles from which you can decide how you would like to set your fees for the Ankle/Foot taping:  29540---$76.96.