Demystifying the Coding of Chiropractic Decompression Therapy | Chiropractic CE
Introduction: The Shift Toward Cash Practices
Chiropractic care has increasingly turned toward cash practices, a move that promises long-term profitability and professional satisfaction. Among the services gaining traction (no pun intended) in these cash practices is chiropractic decompression therapy. Despite its potential benefits, the therapy's coding is a contentious issue, involving manufacturers, the CPT Editorial Panel, and the Department of Health and Human Services.
Chiropractic decompression therapy serves as an alternative or supplementary service in many practices. It attracts clients and improves profitability. However, understanding its coding is crucial for appropriate billing and avoiding legal complications.
The term "decompression therapy" originated with device manufacturers as a marketing tool. They sought to distinguish this form of treatment from conventional traction methods. Their ultimate goal was to sell these devices at prices upwards of $100,000. To justify such a hefty price tag, these manufacturers needed a new code that offered better reimbursement rates than the existing CPT 97012.
Manufacturers initially petitioned for a decompression-specific CPT code, arguing that this new form of traction warranted higher reimbursement. However, the CPT Editorial Panel rejected this request, stating that an existing modality code already defined the physical agent used in decompression therapy.
Subsequently, the Department of Health and Human Services issued a temporary HCPCS code (S9090) to describe this form of traction. However, the code is not valid for Medicare and generally isn't covered by commercial insurance providers. This poses significant challenges, especially in workers' compensation and personal injury cases.
To circumvent these limitations, some practitioners resort to "sounds like" coding. These alternative codes, however, often misrepresent the service provided, putting practitioners at risk of civil or criminal charges.
Despite the industry-wide arguments, it's crucial to remember that the FDA classifies these devices as motorized traction devices, not as specialized "decompression" devices. This distinction plays a significant role in how services should be coded and billed.
While chiropractic decompression therapy offers benefits, both clinical and financial, improper coding can lead to serious repercussions. Understanding the intricacies of coding is essential for any chiropractic practice considering offering decompression therapy as part of their service line-up.
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