PRESCRIPTIONS, CODING, DIAGNOSING & FEES & Mention of Low Level Laser

FL LMT NOTICE REGARDING PRESCRIPTIONS:
I am often asked what is legally required to be on a prescription in order for a FL LMT to be able to bill insurance for a physician’s referred patient.

WHAT THE LAW SAYS:
FL Law enacted October 2nd 1992 states that a prescription must indicate: Duration, Frequency and Diagnoses. It also states which physicians can refer. This law stated MD’s, DO’s, DC’s & Podiatrists

However the new FL PIP law for auto accident cases now eliminates Podiatrists and includes Dentists.

Also necessary is referring Physician’s Name and NPI #

ABOUT PROCEDURES & MODALITIES:
From my many years of experience I find that in order to avoid delays, reductions and denials from insurance companies it is also important for the physician to indicate the procedure and modality we are to use.

Because the majority of physicians are not familiar with the type of training we have had (nor should they have to be concerned with that) it is important that the service we provide is indicated on the prescription.

Thus the reason I created a “prescription” in 1985 with all that’s needed. The therapist should indicate the procedure(s) and /or modality(s) by checking those they normally or most often provide and wish to be reimbursed for by insurers.

Since most LMTs provide more than basic Swedish massage & are trained in deep tissue, neuromuscular therapy and Myofascial release techniques, this must be indicated on prescription in order to be paid for it.

If a prescription states only “Massage” then only 97124 “massage” can be billed. If the LMT has not had training in other procedures or modalities and if a procedure is not in your scope of practice DO NOT BILL IT.

Therefore use the prescription in my manual (CD in back of manual) and check mark the modalities and procedures you personally use. Mark an X by Manual Therapy Techniques, X Hot /Cold Packs and X Initial Evaluation or write it in Other ___________ OR X CPT Code 97799. Do not over do but if you use other modalities often you may wish to X that modality such as Ultrasound, Electrical Stimulation & Hydrotherapy.

Industry Standards are that massage therapists bill, and insurance companies more readily accept it, when no more than 4 procedures are billed and no more than 2 modalities are provided.

Be sure you know the difference and which type of modalities are to be billed by units and which are not, (Supervised vs Constant Contact). The only other thing you might bill would be an initial evaluation when a full complete report is provided and when you evaluate with 20 to 30 minutes of face to face time on new patient visit. Not to be billed when working in a physician’s office. Or a Re Evaluation or Interim Report, established patient only when new prescription is provided. Never use CPT Codes 97001 or 97002. Ask insurance adjuster or use 97799 full report. CPT specifically lists them for Physical Therapy, not Physical Medicine.

This way it eliminates time and decision making for the physician and helps you to be successfully paid.

PRESCRIPTION EXPIRATION:
Be sure you are aware at all times of prescription deadlines and have them renewed prior to continued treatment and billing.

ABOUT DIAGNOSING:
Be 100% sure you NEVER indicate a diagnoses on this prescription as diagnosing is strictly outside our scope of practice.

MORE ABOUT PROCEDURES & MODALITIES:
If you do not have the training, if it is not in your scope of practice and even if it is, and if you cannot comfortably explain in a court of law before a judge and jury, before an insurance company’s defense attorney, then DO NOT USE or BILL IT.

FEE FOR SERVICES:
The exact same thing applies here as above for procedures and modalities. It does not matter what the law says you can bill, be comfortable emotionally, mentally and legally with your fees. Know and understand negative ramifications of over charging as well as over coding and over billing.

Any questions, contact me at: 865-436-3573

Vivian M. Mahoney, LMT
FSMTA Insurance Consultant / Insurance Consultant (19 years)

January 15, 2010

Email: vivianmadison [at] aol [dot] com
Website: www.MassageInsuranceBilling.com

Click here to download Vivian’s previous update with more information about insurance billing .

If you can’t find the answers to your questions here, please feel free to contact Vivian directly.  She is the expert when it comes to billing insurance for massage therapy!

About cold laser and low level laser therapy.
I would highly suggest, if you plan to use this service, be absolutely sure it is in your scope of practice, and that you have liability insurance that covers this service. FSMTA’s insurance provider, the American Massage Council, has coverage that is rated and charged on that rating system, higher risk, more training and higher premium. Check this insurance coverage out here.

Be aware that we as LMT’s have NEVER used HCPCS Codes but have always used CPT Codes.
Read article below I obtained from my research on this issue on Google.com when searching HCSPC Codes.

HCPCS Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services not covered by CPT-4 codes (Level I).

I suggest using a CPT Code for a questionable service and in this case 97799 and I would personally call the insurance adjuster first and make pre arrangements to use this code for Cold Laser Therapy or Low Level Laser Therapy.

Most importantly, be absolutely sure that you have had proper training for patient safety protection, be sure you have liability insurance that specifically covers you in case of injury or complaints of injury. And last but not least, check your scope of practice and see if this service is within your scope of practice. Is this service using a mechanical or electrical device? Does it fit in with the definition of manipulation of the soft tissue?
Vivian M. Mahoney

Laser Therapy and Billing Codes
One of the major challenges practitioners face when using laser therapy in their practice is getting reimbursed for the work they have done. The following are common codes used by practitioners of laser therapy. We are not recommending any particular codes and cannot advise you on billing issues. However, here are some current codes and practices.

While there is no CPT code that defines laser therapy, there is a HCPCS Level II code – S8948 that does reference this service. The S8948 code, which includes a time component, is defined as follows: S8948 – Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes.

It is true that many worker’s compensation and personal injury providers do not recognize HCPCS Level II codes and in such instances CPT 97039 is used.

97039 is an unlisted attended modality code. Reimbursement is good because it is understood to take more time than an unattended code. Being an unlisted code however, it is often rejected or hand audited.

Since codes ending in a ‘9’ are considered unlisted, they require an explanatory summary letter to be submitted in with the claim. The outline of the letter should include your name, patient’s name, date of treatment and a description of modality used.

If anyone is interested in a summary letter, please contact John Mai and he should send you a template to use.

John Mai Email: John [at] irradia [dot] us
Irradia USA
P.O. Box 18947
Irvine, CA 92623
Office: (800) 300-LLLT (5558)
Fax: (310) 775-9749
Web: http://www.irradia.com
Education: http://www.Irradia.us/education