ED Coding and Reimbursement Alert

Question: A patient came into the ED with an injured arm, and the provider gave him an ice pack at first to reduce swelling. Then later in the visit, he gave the patient a hot pack to relax the muscle. Application of both the cold pack and the hot pack is coded as 97010, so can we bill this code twice?

Maryland Subscriber

Answer: Unfortunately, you can’t. Because the definition for 97010 (Application of a modality to 1 or more areas; hot or cold packs) includes the application of both hot and cold packs to one or more regions, it should be billed only once per visit, regardless of the time involved or the temperature of the packs applied. This therapy does not require direct one-on-one patient contact by the provider.

Of note: This code has no practice expense relative value units (RVUs) assigned by Medicare in the facility setting, although some private payers may reimburse for this service.