BCBS Internal Edits and 9016 (Vasopneumatic Devices)

[Guest guest]

Several of the physical therapy clinics that I deal with have purchased Game

Ready Systems and their patients love them. The patients are also getting

better faster according the therapists. Here in Arkansas Blue Cross Blue

Shield has an internal edit that states the only ICD 9 Codes they will allow

you to bill 97016 with are:

457.0 Postmastectomy lymphedema syndrome

457.1 Other lymphedema

757.0 Hereditary edema of the legs

However, our clinics are treating:

729.81 Swelling of limb

782.3 Edema

We find this perplexing since Medicare will pay for all 5 of these diagnosis

codes.

I have taken this up with one of their provider reps who has agreed to take

it back to the medical review department and see if they can include these

other two codes. I have also discussed the matter with the ArPTA president

who has also agreed to follow up with BCBS on the matter, however he would

like research to back up this request. I was wondering if any other states

are having this problem and if anyone could point me to some research

articles that might back up our case.

Thanks to you all!

Becky A. Sewell, MRC, CRC

Rehab Net of AR

P.O. Box 202

Conway, AR 72033

ph/fax