Eli's Rehab Report

Question: I work for a physiatrist who is also a physical therapist. He is thinking about getting the DRX9000 traction machine. Can he bill 97012 in the clinic setting?


Texas Subscriber

Answer: According to the November 2004 CPT Assistant article "Vertebral Axial Decompression Therapy," you should use 97012 (Application of a modality; traction, mechanical) in this situation. The article states, "code 97012 would be the most appropriate code to report for the various types of mechanical traction devices (e.g., computerized/ motorized) including vertebral axial depression."

You may also use HCPCS code S9090 (Vertebral axial decompression, per session) for some payers.

Some coders elect to use the unlisted-modality code, 97039 (Unlisted modality [specify type and time if constant attendance]) to eliminate any potential misrepresentation of services, as well as payers processing and reimbursing for non-covered services. On the other hand, some providers elect to have these services on a patient cash-pay basis.

Before your provider purchases this machine, you should point out that many payers have a noncoverage policy regarding this service. CMS has a National Coverage Determination of noncoverage.

Likewise Aetna, Cigna, Oxford, Wellpoint and the BCBS Associations have similar noncovered or investigational services policies for this type of noninvasive decompression. Best tactic: Check with your top payers regarding coverage before purchasing or leasing these types of machines.

What it is: The DRX9000 is one of the many "computerized tables" on the market that provide an alternative noninvasive, nonsurgical procedure for applying traction to the spine. Typically, these types of machines are fully automated, computerized systems with a split-table design.
 
The patient lies face down, and some type of restraint mechanism (either shoulder or handgrips) restrains movement of the upper body, which is supported on the fixed section of the table. The moveable portion of the table, which supports the lower body, slowly extends, applying a distraction force to the lower spinal area.

Note: The AMA CPT panel is reviewing these services, so check back with Physical Medicine & Rehab Coding Alert for developments.