Neurology & Pain Management Coding Alert

Question: Our practice recently began using a DRX-9000 vertebral axial decompression (VAX-D) machine. The manufacturer of the product has instructed us to code for DRX-9000 services using physical therapy codes, such as 97112, but we-ve been having difficulty recouping payment, particularly from Medicare carriers. Should we be using another code?


Florida Subscriber


Answer: According to section 35-97 of the Medicare Coverage Issues Manual, you should be using CPT code 97799 (Unlisted physical medicine/rehabilitation service or procedure) to report this service.  

Medicare would consider it inappropriate to use physical therapy code 97112 (Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities).

Warning: When it comes to receiving payment for VAX-D therapy, proper coding is only a minor part. Even if your coding is perfect, you should still expect no payment from Medicare carriers. Reason: VAX-D therapy has been noncovered since 2002.

Private payers may differ in their policies, but many will most frequently follow Medicare's lead on coverage determinations. Since you-ve already made the investment in the DRX-9000, you should probably contact your top 5 or 10 payers for their policies on VAX-D and the DRX-9000.