Coding and Billing for Outpatient Rehab Made Easy

CHAPTER 1
Q
A
Q
A
Should we bill ice massage under the CPT massage code 97124 or the unlisted modality code
97039?
Ice massage is considered a modality, so bill it under the unlisted modality CPT code of
97039. Providers should document what they provided on the claim form.
I would expect that you only bill for ice massage once or twice during an episode of care
and that the therapist or therapist assistant would train the patient how to perform the ice
massage independently at home.
I noticed that in 2006, CPT codes 97504, 97520, and 97703 changed to 97760, 97761, and 97762,
respectively. Besides the number changes, have there been any changes in their description and
rationale for use?
The main change involves 97760 (formerly 97504) and its description in the CPT manual,
as well as what this code may include. The new description for 2006 is “Orthotic(s) management
and training (including assessment and fitting when not otherwise reported),
upper extremity(s), lower extremity(s), and/or trunk, each 15 minutes.”
Beginning in 2006, this CPT code may include assessment and the fabrication time when
determining the number of units you can bill when not otherwise reported. Assessment
includes, but is not limited to, determining the patient’s need for an orthotic, determining
the type of orthotic required, ROM and strength testing, sensation testing, and designing
and fabricating the orthotic. This is good news for private practices that treat Medicare
and non-Medicare patients, and for all settings that custom fabricate orthotics.
Under Medicare Part B, all settings besides private practice can bill their Medicare fiscal
intermediary directly for L codes without needing a durable medical equipment (DME)
license. The L code reimburses the supplier or provider for the assessment of the need
for the device, the fabrication time, fitting of the device, and the supplies. Other insurance
payers besides Medicare may allow suppliers or providers to bill for custom fabricated
orthotics, regardless of whether they have a DME license.
38 © 2006 HCPRO, INC. CODING AND BILLING FOR OUTPATIENT REHAB MADE EASY