Published: 2010-02-16 21:00:27
Author: Samuel A. Collins | Dynamic Chiropractic | February 12, 2010
Q: I am concerned about billing for modalities, as they seem more likely to be denied than paid. What can I do to get paid, and is there something else I should be doing to help the process?
A: You are certainly seeing what many others are seeing - a decided utilization protocol that denies modalities or limits payment. As far as the billing of modalities goes, I would assume that as long as you are billing with the correct codes (97010-97028 for unattended and 97032-97036 for attended) that your billing is correct.
For the unattended services, they may be billed only once per visit, regardless of the time spent or number of regions of application. For the attended type, services may billed in units based on the amount of total time spent. However, it is not the billing that is likely the specific reason for denial, but rather the necessity of such services being performed. Here is an excerpt from CIGNA's position on chiropractic that addresses active and passive protocols:
"Passive modalities include treatments such as electrical stimulation, therapeutic ultrasound, high-voltage galvanic stimulation, therapeutic heat, cryotherapy, passive assistive exercise, traction, diathermy and massage. Passive modalities are most effective during the acute phase of treatment, as they are typically directed at reducing pain and swelling."
Note the emphasis on the effectiveness is in the acute phase. Therefore, if passive modalities are done beyond the acute time frame (likely no more than the first four weeks following an injury), the incidence of denial is likely to be higher.
CIGNA
further states: "They (passive modalities) may also be used during the
acute phase of an exacerbation of a chronic condition. The optimal
duration of a course of passive modalities is a maximum of 1-2 months,
after which their effectiveness diminishes, and patient dependency may
develop." I have noted that carriers are denying not only for long-term
use, but also for multiple modalities, which they see as duplicative
and not medically necessary.