Click here to download the transcript.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. We suggest you watch the video while reading the transcript.
Hi everyone. It’s Sam Collins again, you’re coding ability expert. Your expert. Let’s get some things straight. Let’s understand what happens when we’re billing certain codes. And I get this question a lot. We do that service the network where offices can contact me on coding and billing, and one of the big questions I get is, what can I code for mechanical traction?
What type of devices? What does it mean? Can I use a dental roll? What about a roller table? There’s a lot of confusion as to what constitutes mechanical traction, what we use it for, and the why’s, and to make sure we’re getting it paid. Make sure we’re getting it right. So let’s go to the slides. Let’s talk about mechanical traction.
What is mechanical traction? What does it mean? Well, let’s look at the definition. If you look at the standard C P T definition, it says application of a modality, one or more areas. Now realize every modality does that because this is a service that when you. It’s built for one unit, just one or more areas, whether you do it to cervical and thoracic and lumbar.
It’s still one unit and then it says traction mechanical. Okay, so we kind of get the idea of that, but let’s look a little bit more into what that really means. Mechanical traction, it says is the application of sustained or intermittent mechanical unloading of the spine. So we get a kind of a stretching, if you will, of the spinal regions.
The force produces distraction between the vertebra, thereby relieving pain and increasing tissue flexibility. Generally it’s for the cervical and lumbar spines, but it can be argued. It’s gonna happen a little bit in thoracic as well, and devices may include the use of a table style, if you will, a vest.
It could be weights. Even a pneumatic device to an extent would accomplish this and realize it means there’s some type of device that’s doing it. Once applied, it requires only supervision, so you don’t have to be standing over them. You know, as they get it applied, you can make sure it’s on and doing its thing.
Kind of like a hot pack. Put it on, let them relax and then let it go for it. Whatever period of time. And again, I want to emphasize this is billed for one unit and has no value based upon time. Or number of regions. It’s been suggested that spinal elongation through decreasing lardosis and increasing vertebral space, and again, this means cervical and lumbar re inhibits pain or the nociceptive re impulses improves mobility, decreases mechanical stress, reduces muscle spasm, or spinal nerve nerve root compression due to osteophytes or.
Any type of compression, facet syndrome and otherwise releases luxation of a disc or capsule from the zago seal and releases adhesions along the Zago Paso field joint as well in the annulus, fibrous. In other words, taking pressure off the disc and the joint opening up the space, it reduces pain, relaxes muscles as well.
This traction is controlled through the amount of force, whether it’s by pounds or by the weight of the body, if you will, but it’s gonna be a force, and the duration and the angle will also change how much force there is. So you might have the angle change to it. You may have the amount of force that’s in, and it could be static where it’s just all at one time, or usually in.
In fact, what I’ve seen mostly. Is more intermittent where it tractions for a moment than relaxes. Tractions in that force may increase over time. It can include auto traction where you use the own the person’s own body weight, if you will, to create the force as well, which means we have to use some type of gravity as towards that.
Now under Medicare and I’m using Medicare cuz they’re the ones that publish it. They’re saying the typical timeframe is probably three to four times per week for up to two to four months. With 12 to 16 visits being fairly typical to resolve what is necessary. Generally they’re gonna look for a transition where it goes to more homes.
Cuz notice here it says, The modality is typically used in conjunction with therapeutic procedures, meaning not in an isolated treatment. It’s gonna be with manipulation, maybe with exercise, maybe with some other therapies as well. And it’s also done in a way to wean the patient to from an acute to chronic, where they can do maybe, hopefully a self-administered program.
Now, cervical spine, I think, is relatively easy to do over the door pneumatic, but lumbar I think, is a little bit more complicated. That’s why I think lumbar is gonna really require. A little bit more of the mechanical in the office, simply because most people don’t have the apparatus or equipment to do this in a home setting.
Now, keep in mind, documentation should support the medical necessity of continued traction for greater than 12 visits, cuz that’s the Medicare one. Meaning what are we continuing to accomplish? You always think of like with any therapy, what’s my goal? So a person has radiculopathy. Obviously we wanna reduce that.
We wanna change spacing. So we gotta look at how are we gonna measure that goal? Are we gonna measure it based upon, you know, sensory testing, compression testing, orthopedic, functional, but some way to kind of look at how the patients progress, not just, Hey, I feel better. That’s obviously part of it and it says here, we’re trying to look to get it maybe more self-administered.
But as I would point out, I think for cervical, that works lumbar, not so much. Do keep in mind when you spend. Going over the patient about how to use the device at home that’s included in the traction. So realize it doesn’t mean you get to Bill extra. Lucky. Think well can, I’m gonna, I’m gonna go over how to do it at home.
I want to charge more time for that. Well, no, that’s gonna be included in the mechanical traction, however. Realize if you’re giving them a home traction unit such as a vaso nomatic where you’re billing maybe one of the, the hick codes of a E 0 8 55 are similar, that code has a built-in part of it that is part of that counseling or teaching the patient what to do.
I think what I really want to kind of hit on is those, what type of devices would include. Traction. I’ve just used a couple of examples here. Here’s kind of this spinal decompression type or just traction where there’s a harness attached to the lower part of the body. There’s a strap holding the upper part, and you’re basically pulling the patient apart.
Or we can have an over the door traction where the patient is sitting and the harness is pulling the head up and maybe it’s with a weight, maybe it’s intermittent as well, where things get a little tricky though. What about these auto traction, the so-called ventilators or as my dad used to call ’em the roller table, or maybe putting a device here like a a roll where we’re gonna do some things where we’ll stretch.
Well, I think this one immediately you’ll look and go, is this mechanical? Well, I’d say it’s mechanical assist. , but is it mechanical traction? No. This looks me to be more manual traction. This wouldn’t, I think, fit under mechanical. The other devices might, but let’s kinda look a little bit more closely here because the roller table is a very common one.
And if you go back, and this is where you wanna be careful of, so-called Dr. Google. Realize I’ve written articles in Dynamic Chiropractic and other publications since the late nineties, and people often will send me a question, Hey Sam, there was an article you wrote in 2005 about X, Y, and Z. Well, that was true for 2005 and may have been updated.
So when you were gonna look for things that relates to mechanical traction, you might even see the American Chiropractic Association from 2015 has an article that says, well, a roller. Potentially could fit because it’s auto traction, the weight of the body. Well, let’s look at what’s come up more recently.
This is under the Physical Medicine Rehabilitation Journal from 2020. It says, can the use of a chiropractic roller table that is at an adjustable device to create massage and effect along the spine be reported as 9 70 12? So it says, The chiropractic roller table is a device that has adjustable mechanical rollers requiring stationary, supine position of a patient.
The rollers can be adjusted to height and do not require constant one-on-one attendance with a patient to create mass massage and effect along the spine, not even argue a stretching effect. It says The tension via adjustable rollers can be create traction forces resulting in separation between vertebral service.
A review of the literature at the time of this printing does not support a roller table meeting the requirement of auto traction, the use of the body’s own way to create the force and separation between the joints that may be reported with 97 0 12. So I wanna highlight, it’s indicating the roller table does not qualify.
As a mechanical traction, it says, therefore the code 97 39 or the unlisted modality code should be reported when reporting the unlisted service. And you had indicated as a roller table or spinal aid or whatever you want to term determine. The difficulty here is, is that gonna be payable? I’ve had some officers say, no, Sam, I’ve gotten insurances to pay, particularly personal injury.
I’ve had some also with, uh, the VA that will cover it. In fact, the VA actually pays. For 97 0 39, then they do 97 0 12. So from that pure standpoint, it has a little bit better payment. But I wanna be clear that it is not acceptable to use a roller table. Now we can make an argument that we think that it is, but it doesn’t fit the definition.
So we have to be careful. Now what does fit potentially are going to be motorized. Flexion distraction like the Cox table. You notice there’s straps that go over it and the machine itself is motorized to make the movement and pull where there’s forces that stretching it open mechanically. Now, I will suggest don’t do the adjustment at the same time because now that makes it part of the adjustment, which brings me to this type of table.
This is a Cox table. Now the Cox is not motorized and you’re gonna be pumping and moving and in. The Cox table is really what Dr. Cox indicates as a long axial adjustment. Therefore, a motorized flexion distraction where there’s fixation of the parts of the body to stretch would be mechanical traction, but a Cox table would not.
In fact, I wrote an article many years ago about thinking that it was, and I was lamb based by Dr. Cox to basically say, how dare you tell me what my table is. It is part of the adjustment, so be very careful. This is not gonna fit. Manual traction either. Now, what could be auto traction? Well, auto traction could be an an inversion device where you hang upside down, letting the body weight pull.
That certainly makes sense. Obviously, I think we’ll transition the patient to home. I’m not as big a fan of these because the amount of force in the ankle and knees, I prefer the ones that are more from the hips, so it’s stretching the spine, but that’s just me. But that certainly could fit certainly an over the door.
And some people think, well, what about if I put a dinner? Well, is a DeNiro intended for traction or is that just try to retrain the spacing? I think it’s gonna be a little bit of a stretch to indicate that as traction as would be these types of chairs. This chair feels good. I like them. I’ve gone to getting pedicures and manicures and you sit in things like this, they feel good, but does that fit the definition of traction unloading the spine?
Clearly the answer to that is gonna be no, as would be this type of table that uses these water jets under the body. And thinking, Hey, is that gonna be traction as well? No. Again, does it feel good though? Oh, I’m sure it does. . However, is it therapeutic in the way of traction and in fact, would it fit as massage?
No, because it’s not hands on. So I’m gonna suggest, let’s be very careful, do not select a C P T code that merely approximates the service provide. In fact, this is what’s stated directly in the manual. You can’t pick a code to go, well, it’s pretty close. If it doesn’t fit exactly, you cannot use it. So therefore, that’s why we have the unlisted code.
So if you don’t have a service that meets it, exactly, then use the unlisted. The difficulty here is do unlisted codes get paid? By some payers, by many not, and this is where you would explain to the patient, we are doing this service. This service is generally not covered by your plan. They considered experimental investigational, and here’s the charge.
So long as the patient is made aware of it beforehand, they would be liable for it because otherwise it’s maybe a freebie. Now, I’ll give you an example. My dad employed roller tables. He liked them. because patients like them, and so it was a way for him. After the visit, the patients would usually spend anywhere from five to eight minutes on there getting further relaxation and stretching of the spine.
It wasn’t something he billed for. It was just kind of value added. Now, from a pure business standpoint, do you want to have value added or do you want to have reimbursed services? Well, you can look at it two ways. One, I want reimbursed services, but I’m looking for good. and I want something where the patient comes in and has that sense of feeling better, that stretching may be beneficial.
So I think it fits both ways. Where I want you to be careful is don’t just start picking a code because, well, I think this fits. I want everyone to see a roller table does not, and I’m pointing this out because I’ve had offices that have problems. So when they’re documenting it, when you’re doing a roller table, what’s the level, what’s the force?
Where’s the fixation to the body? You can see it doesn’t match where if you’re. , like a true traction. You’ll say, I’m using 25 pounds of pressure intermittently, and I have the legs up at a seven degree angle, or a 50 degree, whatever it might be, which shows you how we’re making the changes to each particular area in the amount of force and time, and then it’s gonna be progressive because over time we generally would increase the force, or I would at least assume that you.
So let’s be careful when using mechanical traction, the obvious devices do, but be careful of kind of dovetailing something into it. Kinda like that Shsu massage thing where we go into like a pedicure place. Remember, we’re always here to help the HJ Ross Company, along with ChiroSecure always wants you to be successful and have the best ways to do that.
We offer a service where I can work with you one-on-one, click that QR code here and take a look at what we offer. Get ahold of. And we can talk one-on-one, even do Zooms to make sure you have all the right billing practices and frankly just get reimbursed better. I help you with everything, not just coding, but all levels of reimbursement.
What we want, of course is success and to make sure that your patients are getting the best possible care as I wanna make sure you get the best possible information. So I wish you all well and I’ll see you next time. Thanks everyone.