What is the CPT code for Pope 2 way extension compression traction?

Answer 1

Two codes are appropriate for CBP Pope cervical extension traction. 97112 and 97012 are the appropriate codes, however, the utilization of the codes should be decided upon by the intent of the procedure, not only the application. According to CPT guidelines, a specific treatment plan should be designed for a specific patient's diagnosis and condition, and the therapeutic goal of that treatment plan is the reason and rational for what procedure codes should be utilized, along with how they are applied in the treatment setting, and what parameters are contained within the code definition.

CPT CODE 97012: Application of a modality to one or more areas, traction, mechanical, is intended to identify a procedure that creates a force to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds or Newtons) allowed, duration (time) and angle of pull (degree) using mechanical means. Therefore code 97012 would be an appropriate code to report for various types of mechanical traction devices (eg, static/computerized motorized) including vertebral axial decompression.

CPT CODE 97112: Therapeutic procedure, one or more areas, each 15 minutes - Neuromuscular Reeducation of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities. This is a therapeutic procedure, a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. Physician or therapist required to have direct (one-on-one) patient contact.

This procedure is used to improve balance, coordination, kinesthetic sense, posture and proprioception. This procedure is reasonable and medically necessary for impairments, which affect the body's neuromuscular system (i.e., poor static or dynamic sitting/standing balance, loss of gross and fine motor coordination, hypo/hypertonicity).Examples include Proprioceptive Neuromuscular Facilitation (PNF), The Feldenkrais Method, Bobath, Bap's Boards and Desensitization Techniques.

Utilizing the above definitions, your treatment plan should be specific and describe your clinical rationale for performing 97012 or 97112 as well as the goals and applications. Although the 97012 code can describe CBP based 2-way traction application, it does not define the intent or rationale of the how the goals are to improve static and dynamic posture, proprioception and kinematic sense in daily activities as the 97112 code does. Your patient history and exam findings should relate to the patient having difficulties and impaired functional capacity with certain movements, balance, coordination, kinesthetic sense, posture and/or proprioception if you choose to utilize the 97112 code. The plan of care should also outline what specific parameters will be used for 97112, and why. Moreover, the one on one contact verbiage requires direct supervision with this code. If your patient is not supervised while in 2-way traction set-ups, the 97112 code may be deemed inappropriate.

Many insurance companies will gladly pay the 97012 code without issue, while denying the 97112 code. They may also try to bundle these codes when utilized with an adjustment code. While this is completely inappropriate, they do this for because the 97112 code has been misused for manual therapies, axial traction and intersegmental traction tables in the past, the 97012 code is over utilized, and they bundle because many doctors will not rebuttal the denial due to their poor documentation. You must be able to effectively communicate to a third party carrier why the code you have utilized is appropriate. Proper diagnosis and treatment plans which include goals and proper documentation of how the procedure is utilized within the CPT parameters is how you do this correctly.

Lastly, never forget the time component. According the CMS, you must reach a minimum of 8 minutes in a one on one therapy to qualify for that code. So if your patient only completes 4 minutes of 2-way traction with an additional 2 minutes of set-up time and education, you are short of the 8 minute minimum. Therefore, you would have to add a modifier for shortened duration of applied therapy/treatment for that code to be billed correctly. It is then up to the third party carrier to either allow, deny, or partial pay for that service. Personally, I do not bill partial units for any therapy utilized in my office that does not meet the appropriate time component, even though the codes do allow for this. Just my 2 cents, hope it helps

Dr. Shawn Leatherman