Internal Medicine Coding Alert

Question: How should I code for an anodyne therapy system for our diabetic peripheral neuropathy program? I can't find any codes that describe this kind of therapy.

Answer: Anodyne therapy is a U.S. Food and Drug Administration (FDA)-approved therapy that uses nearinfrared photo energy to reduce pain and improve circulation and has shown promising results in patients with diabetic peripheral neuropathy.

There is no CPT code specifically for anodyne therapy. The AMA recommends and most carriers recognize 97039 (Unlisted modality, constant attendance), according to the Tampa, Fla.-based Medassist Group, which manufactures and distributes the anodyne therapy system. Medicare carriers in Florida and California have paid for anodyne therapy for diabetic peripheral neuropathy patients using this code, and a Florida podiatrist prevailed in a Medicare fair hearing when he billed this code and the carrier challenged the treatment's medical necessity, says Medassist President Craig Turtzo.

In Maryland, the Medicare carrier pays for anodyne therapy coded with 97026 (Application of a modality to one or more areas; infrared), even though the therapy is near infrared, not infrared, Turtzo says. Ask your carrier how you should code this therapy.

Typically, anodyne therapy is administered in thrice-weekly, 45-minute sessions. Some providers also see the patient weekly to assess the treatment's effectiveness and use a low-level E/M code (such as 99212) for this visit.