by Wyn Staheli, Director of Content - innoviHealth
Dec 20th, 2018
Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article further clarifies the previous Q/A.
Please note that the original question did not mention any special ‘optional’ equipment so our answer was based on their question. It is our understanding that the majority of providers do not add the additional or optional components. Also keep in mind that there are other brands of equipment so we will refer to this as flexion-distraction technique.
Our answer was based on the standard of coding guidelines and rules including policies issued by the American Chiropractic Association (ACA). According to the American Chiropractic Association (ACA) Policy (emphasis added)
Flexion distraction is a Chiropractic Manipulative Technique. Per the preamble of the CMT code set (98940-98943) it is a procedure that is a form of manual treatment to influence joint and neurophysiological function. The physician work included in CMT codes was laid out in a work value survey of the chiropractic profession conducted in the spring of 1996 and included the work of flexion distraction. The procedure is taught in the curriculum in accredited chiropractic programs and institutions. Therefore, the appropriate coding for this technique is 98940, 98941, or 98942, depending on the number of other body regions treated.
According to Brandy Brimhall CPC, CMCO, CCCPC, CMCO, CPMA, “... traction [is] a code that is very commonly audited and refunds are requested for inappropriate use of the code, lack of medical necessity for the service and even evidence of excessively and routinely performing the procedure whereas reimbursement would not be allowed. So, if a question coming in does not clearly identify that there may be some special circumstances that need to be considered or evaluated, our responses will be directed toward the standard rules and guidelines in effort to minimize risk of audit and vulnerability to the practice.”
So let’s look at what the ACA has to say about code 97012 (emphasis added):
Procedure Code 97012, Mechanical Traction/Spinalator
The American Chiropractic Association (ACA) receives numerous requests for clarification on describing the work associated with mechanical traction. According to CPT, mechanical traction is described as the force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction are intermittent or static (describing the length of time traction is applied), or autotraction (use of the body's own weight to create the force). A common question is whether roller table type traction meets the above requirement. Roller table type traction normally meets the requirement of autotraction, the use of the body's own weight to create the force. It is the position of the American Chiropractic Association that modalities such as mechanical traction are not included in the work of the CMT codes. Code 97012 should be used to describe these services, subject to documented medical necessity.
The bottom line is that even if you feel that the additional, optional equipment justifies the use of code 97012, according to Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow, “go ahead and bill as 97012 as long as you feel like the work you are doing meets the criteria for the code and you feel you could win an argument with a claims reviewer or auditor.” If you do decide to go ahead and bill this service, be sure to document the key terms in bold above: type (e.g., static, intermittent, autotraction), amount of force (pounds), duration (time), and angle of pull (degrees).
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.