You Be the Coder:
Topical Gel for Therapy
Published on Mon Jul 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We have started using a topical gel for patients after physical therapy. It causes a very cold (almost freezing) sensation and helps ease pain and swelling. Is there a code for this?
Colorado Subscriber
Answer: You can bill for the freezing gel with CPT 97010 (Application of a modality to one or more areas; hot or cold packs), but Medicare and most other payers will not reimburse separately for this procedure when it is performed on the same day as any other procedure. It is a "bundled" code, which means that it will always be denied.
If the gel is costly, you should ask the supplier if there is a HCPCS code that you can bill for the supplies. If patients request the gel and it is not reimbursable, you can tell them it is a noncovered service, but ask them to pay for it. Medicare patients should first sign an advance beneficiary notice (ABN), demonstrating that they understand their responsibility for the costs.
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