Question: What CPT or HCPC should be used when billing Spinal Decompression to insurances (like Aetna, Cigna and/or Medicare)?
Answer:
Many payers recognize/use 97012 – mechanical traction for Spinal Decompression. Other options within CPT would be to use the unlisted codes of 97039 or 97799 in the Physical Medicine Section. 97039 is an “unlisted modality” for 15 minutes of constant attendance. 97799 is for “unlisted physical medicine/rehabilitation service or procedure.” However, both of these codes would need a report/explanation to the payers.
There is also S9090 within the HCPCS code sets. It is for “Vertebral axial decompression, per session.” However this code is not recognized by very many payers.
It is my understanding that the unlisted codes can only be used if there is no other code that can describe the procedure being done. Since S9090 IS vertebral axial decompression, except for Medicare(which requires 97799 to be billed for spinal decompression), shouldn't S9090 always be billed for spinal decompression?
S9090 is the most appropriate code to use for spinal decompression. You should always use the most appropriate CPT (procedure code) that best describes the service(s) performed. However, in some cases the insurance company will not allow/recognize CPT S9090. They require the CPT code 97799 with description of that procedure.
does a modifer need to be included for spinal decompression done in the office if so what cpt code should i use 97012 97799 97039
Bonita, no modifier is necessary when billing for this service. S9090 is the most appropriate code to use for spinal decompression. You should always use the most appropriate CPT (procedure code) that best describes the service(s) performed. However, in some cases the insurance company will not allow/recognize CPT S9090. They require the CPT code 97799 with description of that procedure.