November 21st, 2014
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the coverage and benefits for individual policies. Providers must be aware that some states, as well as some individual payers, specify which codes they prefer to be used for specific services. It is up to the provider to regularly obtain this information and apply it as required. Medicare does not cover laser therapy for chiropractic in any region.
The information below consists of common codes that are applicable for use when performing laser therapy. Again, if another code is required with an individual payer or within a specific state, providers must adhere to those guidelines. Providers should always seek counsel from individual states and payers for any specific requirements. Please see common codes used for laser therapy below:
S8948: Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes
Note: Because laser is often performed in less than 15 minutes, the Modifier -52 may be applicable in these cases so as to indicate that less than a full unit of this service was performed
97139: Unlisted therapeutic procedure (specify)
Note: When using this code, clarity of your procedure must be listed in the red shaded area above the code on the claim form.
Additional coding tips: Recognize that laser therapy is often performed in conjunction with another treatment or active therapy. Due to this, there are other codes that may be applicable for billing and qualify for reimbursement in addition to the actual laser therapy service. Of course, when submitting any of these additional codes, records must very clearly identify Medical Necessity, the service that was performed and meet specific documentation guidelines to fully support any and all codes used.
*Nebraska* Nebraska practices are required to use code 97139 for laser therapy for BCBS. 'Low-Level-Laser' or 'Cold Laser' must be printed in the red shaded area on the claim form to identify the service.
The following ABC (Advanced Billing Concepts) codes may be of interest for proper recording and reporting for specific services where codes may not be listed clearly elsewhere. These codes are intended for use for non-insurance and wellness services.
The ABC codes listed below are not intended to be submitted to insurance for payment as they will not be recognized for processing and coverage by payers. These ABC laser codes are:
BAEAC: Cold laser therapy each treatment
BAEAG: Erchonia Therapeutic Low Level Laser PL/Series, each 5 minutes
DOCUMENTING FOR LASER THERAPY
Documentation of your services is necessary to accomplish:
- Supporting Medical Necessity
- Verification that the service was indeed performed
- Identifying the benefits of or purpose of performing a procedure
- Demonstrating change or improvement in a patient condition/symptoms from visit to visit
Proper and complete documentation of all services is critical. The information below will describe what must be documented specifically for laser therapy services:
- Reason or purpose for performing this service. What is it intended to accomplish?
- Length of time laser therapy was performed
- Region of the body laser therapy was applied
- Doctor observations or new findings during or after laser therapy (as applicable)
- Patient comments if applicable (increase of or reduction of pain, increased ROM, etc)
What is 'Constant Provider Attendance'? You will notice that service code S8948 requires Constant Provider Attendance. The definition of Constant Attendance is determined by each state individually. Providers should, at least annually, contact their local state organization to determine how this is defined in their own states. Many services codes that are used in chiropractic require Constant Provider Attendance.
Why use non-insurance codes like ABC? Regardless of a practice type, services must be coded. Coding is a language that can be interpreted globally. Even patient records where there is no insurance involvement can be requested for review from various sources. While documentation should always be detailed and thorough, coding is generally a primary resource that reviewing parties would reference when determining what services were rendered to patients. As a measure of patient safety, both documentation and coding are critical components of a complete record.
In instances where a standard service code is not applicable or available, an ABC code may be the best option. In fact, there are ABC codes that are specific to some Erchonia instruments.
How do I better understand coding? Current year coding resources are necessary for proper coding. At a minimum, practices should review at least those codes that are currently used. Any uncertainties should be researched to confirm proper use. One should never assume the use of a code or use a code that doesn't clearly define the service being rendered. There are many resources available to seek help for assistance in being confident with coding. To maximize reimbursement and to fully support documentation, providers should become familiar with all codes that are available for use and the documentation guidelines for each.