Do you offer mechanical traction in your chiropractic office? Or maybe you already do but you are wondering how to use it correctly on claims for better reimbursement.
97012 CPT Code for Chiropractic Services
Chiropractic CPT Code – 97012 – is used for mechanical traction.
What is Mechanical Traction
Mechanical Traction is a supervised modality that does not require one-to-one patient contact. A qualified healthcare professional will apply gentle traction force or weight to pull away the vertebrae. This helps to relieve pain and widen intervertebral foramen, and provides relief from nerve root impingement.
Mechanical Traction is an effective treatment for patients suffering from herniated disc, general neck, arm, leg and back pain, carpal tunnel syndrome, degenerative disc joint disease, etc. depending on the patients’ condition, spinal level, and tolerance level, the traction force can be applied intermittently or as a continuous force.
Who Can Apply Mechanical Traction in Chiropractic Office?
Usually, chiropractors apply mechanical traction, some states in the US also allow staff members, such as trained Chiropractic Assistant, to assist with mechanical traction. It is important to check with your state laws for the scope of practice when it comes to applying mechanical traction.
It is important to note that the provider must be present in the office when a Chiropractic Assistant performs these therapies, but it is not necessary for the provider to be in the same room where the patient is being treated with mechanical traction.
The Coding Policy and 97012 CPT Code Description
The American Chiropractic Association (ACA) provides a clarification on the work associated with CPT code for mechanical traction.
According to CPT coding policy, 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.
“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.”
When to Use the Chiropractic CPT Code – 97012
To use 97012 mechanical traction code correctly, a chiropractor must meet the following criteria:
- The traction must be mechanical in nature. This means that roller tables, Y-straps and manual traction are not covered under this code.
- The traction must abide by the 15 minute time rule.
Modifiers for Billing Mechanical Traction with CPT Code 97012
When billing for mechanical traction services with CPT code 97012 in your chiropractic clinic, you may need to these 97012 modifiers:
- Modifier 59: Indicates that the traction procedure was performed separately and independently of other services.
- Modifier GP: Shows that the service provided is therapeutic in nature. This modifier is often required by some insurance payers for services performed by chiropractors or physical therapists.
- Modifier GY: Used to obtain a denial on a non-covered service. This modifier informs Medicare that you are aware the service is excluded. It is required on Medicare therapy CPT codes that will not be covered, allowing you to bill the patient directly.
For instance, when billing 97012 to BCBSNC and NC State Health Plan (SHP), you must append 97012 with modifier GP.
Challenges Associated with CPT Code 97012
There are several challenges associated with using CPT code 97012, such as:
a. Complexity
As compared to all the chiropractic billing codes, CPT code 97012 is a complex one. It covers a wide range of rehabilitation services, such as therapeutic exercises, manual therapy, range of motion (ROM), massage therapy, and modalities.
This complexity often makes it difficult for chiropractors to accurately select the appropriate code when billing insurance payers.
b. Insurance Coverage
Insurance coverage is another challenge associated with the chiropractic procedure code 97012. Some insurance payers have strict guidelines for what they will cover.
c. Precise Documentation
Precise documentation is critical when using CPT code 97012. This documentation must be accurate, complete, and timely to ensure that insurance claims are processed efficiently and effectively.
Documentation Needed for Using 97012 CPT Code
When billed to a payer, 97012 CPT code for mechanical traction must be properly documented in the patient chart and accurately reported. Here are the important points that the patient document should include:
- The date of the procedure
- The type of traction device used
- The duration of the procedure
- Area(s) of application (specific region treated)
- The Etiology of symptoms requiring treatment
- Setting and frequency (as applicable)
- If time based code, actual time service performed
- The treatment must be medically necessary and consistent with the chief complaint, diagnoses and treatment plan.
- The rationale for the 97012 therapy
- The document must clearly establish the medical necessity
Important things to keep in mind when using CPT code 97012
1. Can you use a chiropractic roller table and report it as manual traction? According to the journal Physical Medicine and Rehabilitation as of July 2020, the chiropractic roller table does not meet the requirements of auto traction billed as code 97012.
The chiropractic roller table should be reported with code 97039, Unlisted modality (specify type and time if constant attendance).
2. Use the correct modifiers when billing for the procedure code 97012.
3. 97012 is payable by some insurance payers. However, it’s crucial to understand the payer’s requirements for billing for mechanical traction.
4. Only one unit of the 97012 code can only be reported per session. It doesn’t matter whether mechanical traction is applied in one body part or more areas. The code description states “application of a modality to one or more areas.”
Conclusion
The chiropractic CPT code 97012 is a complex code. Understanding the challenges, coding policy, and documentation requirements will help chiropractic billers to correctly bill the insurance payers. By understanding how to use this code and 97012 CPT code reimbursement process, chiropractors can provide better care to their patients and ensure that they are properly reimbursed for their services.
Best Alternative to 97012 Chiropractic Code Challenges
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