Guest guest Report post Posted October 19, 2010 Rick, Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Rick Gawenda Sent: Monday, October 18, 2010 6:01 PM To: PTManager Subject: Re: Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@...<mailto:nmullins%40holzerclinic.com>> wrote: > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 19, 2010 I think the key is in documentation, what is the reason the modality is being used. i.e. application of ice massage for cold effects versus movement of tissue. Generally ice is used to cool tissue, so if it is not clear that your intent is different, the payer is not going to try and figure out what your intent was so they can pay you. Also, a few members in our profession, have purposely billed incorrectly to re-coop higher payments which has led to stricter guidelines. And whether we agree with the payment guidelines or not, we need to follow them to get reimbursed and lobby though appropriate channels to get them changed when we are not in agreement rather than going around them. Diane , PT DPT Langlade Hospital Antigo, WI ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Milano, Dave Sent: Tuesday, October 19, 2010 7:52 AM To: PTManager Subject: RE: Rick, Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Rick Gawenda Sent: Monday, October 18, 2010 6:01 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: Re: Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@... <mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com>> wrote: > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 19, 2010 I believe that the CPT advisor and Medicare recognize the application of ice massage, moist heat and cold as modalities that patients can perform safely and independently with minimal instruction. Frequently, I will perform one visit of ice massage + instruction (3-5 minutes tops) and then let the patient perform subsequent ice massages independently. Most patients with an I.Q. North of 85 can perform their own ice massage after 1 treatment and instruction. Hand them an ice cup, a towel, a timer and tell them to throw the left over ice in the sink when they're finished. We can argue semantics all day long amongst ourselves. However, I don't believe it would go over well if we had to frequently address this type of billing with a patient with questions about their E.O.B. I imagine it would feel a bit awkward trying to explain why I charged them a unit of massage (CPT 97124) for the 3 minutes I spent rubbing an ice cube on their knee. Jon Mark Pleasant, PT Methodist Medical Center > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > MullinsPT > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 19, 2010 I appreciate you addressing your response to me, but responses should not be specific to an individual as many others may and have commented on your response. In my opinion, ice massage is not massage. Filling a foam cup with water, freezing it, tearing some of the foam away, and rubbing it over a body part would not be considered massage by many of the reviewers I know. That CPT Assistant has addressed this modality is another reason I feel, as well as others do, that ice massage falls under CPT code 97010. We/I can't help that many payors do not reimburse for CPT code 97010. I think they should as there is a clinical reason why we choose this modality and there is a risk to the patient in the use of this modality. It is called a burn or frostbite. We/I/You need to change these policies that are put in place by third party payors, sometimes for no apparent reason or with sound research. Rick Gawenda, PT President/CEO Gawenda Seminars & Consulting www.gawendaseminars.com > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 20, 2010 Dave, Sounds like you are still applying ice, not a massage. Billing for massage sounds like fraud to me. Matt Dvorak, PT Yankton ________________________________ From: PTManager on behalf of Milano, Dave Sent: Tue 10/19/2010 7:51 AM To: PTManager Subject: RE: Rick, Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Rick Gawenda Sent: Monday, October 18, 2010 6:01 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: Re: Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com <http://www.gawendaseminars.com/> On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@... <mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com>> wrote: > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 21, 2010 I will try to explain this carefully. And since a suggestion of fraud is no small matter, I will appreciate careful reading. The specific case I had in mind was the treatment of an injured hand. The therapist had determined that soft tissue massage was necessary to reduce finger edema, but the patient found the process too painful, so a small block of ice was contoured to the patient's finger, and massage was intermittently applied with the ice as well as with the therapists hands (mostly with the ice). This was more tolerable to the patient, and thus more successful. What was therefore used as treatment was defined by code and by general understanding as ice massage. Now would a reasonable person consider that equivalent to a monitored ice pack? Clearly what is at work here are factors outside the reality of patient-provider actions. Broad-brush rules are being written and enforced irrespective of the very real and reasonable needs of patients and providers. Rule-makers have defined what healthcare is, what it costs, and when and to whom it can be delivered. That is not good, it is not right, and we should not presume ourselves right when we go along with it. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Matt Dvorak Sent: Wednesday, October 20, 2010 2:57 PM To: PTManager Subject: RE: Dave, Sounds like you are still applying ice, not a massage. Billing for massage sounds like fraud to me. Matt Dvorak, PT Yankton ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> on behalf of Milano, Dave Sent: Tue 10/19/2010 7:51 AM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: Rick, Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Rick Gawenda Sent: Monday, October 18, 2010 6:01 PM To: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> Subject: Re: Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com <http://www.gawendaseminars.com/> On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@...<mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com>> wrote: > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 21, 2010 Keep in mind this so called rule was not developed by insurance carriers, rather, clarified by the American Medical Association (AMA). If we disagree with their intent, we then need to address our concerns to the AMA and see if we can het it changed. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com > I will try to explain this carefully. And since a suggestion of fraud is no small matter, I will appreciate careful reading. > > The specific case I had in mind was the treatment of an injured hand. The therapist had determined that soft tissue massage was necessary to reduce finger edema, but the patient found the process too painful, so a small block of ice was contoured to the patient's finger, and massage was intermittently applied with the ice as well as with the therapists hands (mostly with the ice). This was more tolerable to the patient, and thus more successful. What was therefore used as treatment was defined by code and by general understanding as ice massage. Now would a reasonable person consider that equivalent to a monitored ice pack? > > Clearly what is at work here are factors outside the reality of patient-provider actions. Broad-brush rules are being written and enforced irrespective of the very real and reasonable needs of patients and providers. Rule-makers have defined what healthcare is, what it costs, and when and to whom it can be delivered. That is not good, it is not right, and we should not presume ourselves right when we go along with it. > > Dave Milano, PT, Rehabilitation Director > Laurel Health System > > > ________________________________ > From: PTManager [mailto:PTManager ] On Behalf Of Matt Dvorak > Sent: Wednesday, October 20, 2010 2:57 PM > To: PTManager > Subject: RE: > > Dave, > Sounds like you are still applying ice, not a massage. Billing for massage sounds like fraud to me. > Matt Dvorak, PT > Yankton > > ________________________________ > > From: PTManager <mailto:PTManager%40yahoogroups.com> on behalf of Milano, Dave > Sent: Tue 10/19/2010 7:51 AM > To: PTManager <mailto:PTManager%40yahoogroups.com> > Subject: RE: > > Rick, > > Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? > > If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? > > Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. > > Dave Milano, PT, Rehabilitation Director > Laurel Health System > > > ________________________________ > From: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Rick Gawenda > Sent: Monday, October 18, 2010 6:01 PM > To: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> > Subject: Re: > > Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. > > Rick Gawenda, PT > President/CEO > Gawenda Seminars > > http://www.gawendaseminars.com <http://www.gawendaseminars.com/> > > On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@...<mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com>> wrote: > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > MullinsPT > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 21, 2010 Dave, The Devil is in the details. I believe most PT's envision ice massage as circular rubbing of an ice cup on a particular body part for 3-5 minutes and nothing more. Therefore, when a PT suggests that a typical ice massage be billed as 97124 (massage), most PT's will conclude that this is a questionable billing practice. Diane hit the nail on the head stating that documentation is paramount (paraphrased). If a PT incorporates the use of an ice cup for analgesia along with traditional massage or soft tissue manual techniques intermittently for a significant amount of time (more than 3 minutes), most would agree that a PT could bill 97124 or 97140 respectively. One should document accordingly to differentiate this type of treatment from a simple ice massage. Lastly, written communication in forums is often lacking in all the facts to draw accurate conclusions from the very beginning. Readers will arrive at a conclusion (true or false) based on the limited information provided. Jon Mark Pleasant, PT Methodist Medical Center > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > MullinsPT > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 21, 2010 Well I would have to agree that this could be considered as manual work. I would also consider doing a cross friction massage over the biceps tendon manual therapy. I use a cone shape ice to perform this treatment that gets better results than with my finger and a pack of ice later.  Geno R. , PTA, CSCS Physical Therapist Assistant and Strength Coach. 4247 E Roma Ave Phoenix, AZ 85018 Cell ________________________________ To: PTManager Sent: Thu, October 21, 2010 8:11:53 AM Subject: RE:  I will try to explain this carefully. And since a suggestion of fraud is no small matter, I will appreciate careful reading. The specific case I had in mind was the treatment of an injured hand. The therapist had determined that soft tissue massage was necessary to reduce finger edema, but the patient found the process too painful, so a small block of ice was contoured to the patient's finger, and massage was intermittently applied with the ice as well as with the therapists hands (mostly with the ice). This was more tolerable to the patient, and thus more successful. What was therefore used as treatment was defined by code and by general understanding as ice massage. Now would a reasonable person consider that equivalent to a monitored ice pack? Clearly what is at work here are factors outside the reality of patient-provider actions. Broad-brush rules are being written and enforced irrespective of the very real and reasonable needs of patients and providers. Rule-makers have defined what healthcare is, what it costs, and when and to whom it can be delivered. That is not good, it is not right, and we should not presume ourselves right when we go along with it. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager [mailto:PTManager ] On Behalf Of Matt Dvorak Sent: Wednesday, October 20, 2010 2:57 PM To: PTManager Subject: RE: Dave, Sounds like you are still applying ice, not a massage. Billing for massage sounds like fraud to me. Matt Dvorak, PT Yankton ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> on behalf of Milano, Dave Sent: Tue 10/19/2010 7:51 AM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: Rick, Understanding that your position necessitates advice be given according to strict rules of compliance, what are we to make of a rule dictating we must say something is what it is not? If a therapist uses his hands to move fluid with massage it is, what? Massage? Soft tissue mobilization? But if there is an ice cube between his fingers and the patient, it is a monitored ice pack? Are the controls placed upon us so dense that truthful coding puts us in danger? Somewhere along this crazy continuum it seems therapists must make a stand for reason and truth. If we cannot do so now in even the tiniest of actions, the trouble that awaits us in the future will be immense indeed. Dave Milano, PT, Rehabilitation Director Laurel Health System ________________________________ From: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Rick Gawenda Sent: Monday, October 18, 2010 6:01 PM To: PTManager <mailto:PTManager%40yahoogroups.com> <mailto:PTManager%40yahoogroups.com> Subject: Re: Per the American Medical Association, in one of the editions of CPT Assistant, you are to bill ice massage under 97010. Don't quote me since I am not at my computer, but I believe it was the August 2007 edition. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com <http://www.gawendaseminars.com/> On Oct 18, 2010, at 11:38 AM, Mullins <nmullins@...<mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com> <mailto:nmullins%40holzerclinic.com>> wrote: > When we have used Ice Massage we have typically billed the CPT 97010 with the >intent of the gaining the effect of the cold. Is anyone using the CPT code >97124/Massage? > > MullinsPT > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 21, 2010 A question for the writer of the post below, why did you use more than 3 minutes as a significant amount of time to be able to bill for a 15 minute time based CPT code? Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com > Dave, > > The Devil is in the details. > > I believe most PT's envision ice massage as circular rubbing of an ice cup on a particular body part for 3-5 minutes and nothing more. > > Therefore, when a PT suggests that a typical ice massage be billed as 97124 (massage), most PT's will conclude that this is a questionable billing practice. > > Diane hit the nail on the head stating that documentation is paramount (paraphrased). > > If a PT incorporates the use of an ice cup for analgesia along with traditional massage or soft tissue manual techniques intermittently for a significant amount of time (more than 3 minutes), most would agree that a PT could bill 97124 or 97140 respectively. One should document accordingly to differentiate this type of treatment from a simple ice massage. > > Lastly, written communication in forums is often lacking in all the facts to draw accurate conclusions from the very beginning. Readers will arrive at a conclusion (true or false) based on the limited information provided. > > Jon Mark Pleasant, PT > Methodist Medical Center > > > > > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > > > MullinsPT > > > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 22, 2010 Rick, I wasn't implying that 3 minutes should be a defining amount of time after which one should bill for services. I merely chose 3 minutes because it is a common amount of time for a basic ice massage. I'm sorry my point was unclear. To be clear, I believe that 3 minutes is an insignificant amount of time as it relates to billing for any service. Though others on this forum may vehemently disagree, I believe the Medicare 8 minute rule is both logical and reasonable. In addition, the billing department at the facility I work for recommends that this type of billing guideline be applied for all payors. Therefore, I follow Medicare's 8 minute rule for all my patients. I am in full agreement with Diane , PT, DPT when she said, " Whether we agree with the payment guidelines or not, we need to follow them to get reimbursed and lobby though appropriate channels to get them changed when we are not in agreement rather than going around them. " Lastly, I believe that " creative billing " that circumvents or seeks to significantly bend CPT definitions constitutes both questionable business practice and ethics. This is merely my unsolicited personal opinion. Jon Mark Pleasant, PT Methodist Medical Center > > > > > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > > > > > MullinsPT > > > > > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted October 24, 2010 Thank you for your clarification. I would also caution that Medicare's " 8-minute rule " is only for the Medicare program unless other payors also state they follow the " 8-minute rule " in their policies. I am not a proponent of using the " 8-minute rule " with non-Medicare payors and encourage the use of " each 15-minutes " of which you must do a substantial portion. The question everyone has is what constitutes substantial? In the December 2003 edition of CPT Assistant, the American Medical Association (AMA) provided 2 examples. In one of the examples, they said the therapist provided 25 minutes of manual therapy and the AMA said that since a substantial portion of the 30 minutes was provided, it was their intent you would bill 2 units of manual therapy. In the second example, the therapist provided 10 minutes of self care/home management. The AMA stated that since a substantial portion of the 15 minutes was provided, it is their intent you would bill 1 unit of self care/home management. That leads us to another question in my opinion. Is 4-6 minutes of manual therapy substantial if that is all the patient required and results were achieved in the impairments which then improved function? At what amount of minutes do you not feel " guilty " concerning the billing of that intervention? At what amount of minutes do you not append modifier 52 to the CPT code on the claim form? Still grey areas out there open for interpretation. Rick Gawenda, PT President/CEO Gawenda Seminars & Consulting www.gawendaseminars.com Subject: Re: To: PTManager Date: Friday, October 22, 2010, 1:46 PM  Rick, I wasn't implying that 3 minutes should be a defining amount of time after which one should bill for services. I merely chose 3 minutes because it is a common amount of time for a basic ice massage. I'm sorry my point was unclear. To be clear, I believe that 3 minutes is an insignificant amount of time as it relates to billing for any service. Though others on this forum may vehemently disagree, I believe the Medicare 8 minute rule is both logical and reasonable. In addition, the billing department at the facility I work for recommends that this type of billing guideline be applied for all payors. Therefore, I follow Medicare's 8 minute rule for all my patients. I am in full agreement with Diane , PT, DPT when she said, " Whether we agree with the payment guidelines or not, we need to follow them to get reimbursed and lobby though appropriate channels to get them changed when we are not in agreement rather than going around them. " Lastly, I believe that " creative billing " that circumvents or seeks to significantly bend CPT definitions constitutes both questionable business practice and ethics. This is merely my unsolicited personal opinion. Jon Mark Pleasant, PT Methodist Medical Center > > > > > > > When we have used Ice Massage we have typically billed the CPT 97010 with the intent of the gaining the effect of the cold. Is anyone using the CPT code 97124/Massage? > > > > > > > > MullinsPT > > > > > > > > Quote Share this post Link to post Share on other sites
