Correct Coding for Laser Therapy
RISK MANAGEMENT
Service Codes define "what" you're doing. Diagnosis codes define "why" you're doing it.
Brandy Brimhall
CPC, CMCO, CCCPC, CPCO, CPMA
These days, more practices are learning about the treatment benefits of laser therapy and, as such, are implementing this instrument and service into their protocols. With the laser in hand being utilized for patient care, the common realization is that some information is missing that the practice hasn’t yet considered. I am regularly presented with questions regarding laser, and the following most commonly arrive in my inbox:
“Does insurance cover laser therapy? ”
“How do I document for laser therapy? ”
“How do I code for this? ”
Get to Know Your Instrument
As we discuss these questions throughout this article, let’s first address a few key components. First, whenever being asked about laser therapy, I always identify the unit being used to verify that it is indeed laser therapy. So, let’s begin by clearing some of the cobwebs surrounding laser therapy coding and billing. You must know the type of instrument you have, not only for coding purposes but also for proper marketing in your region. Even marketing can be misleading if you are promoting laser therapy but do not have a laser. There is ongoing confusion among actual laser, LED, and infrared therapies. Importantly, some instruments are even multifaceted and may have the capabilities of two or even all three of the laser, LED, and infrared therapy functions.
If you truly aren’t sure what type of unit you have, I would encourage you to avoid assumption and reach out directly to your sales representative or manufacturer to ask for documented confirmation. Some lasers even have FDA clearance for certain types of treatment. In this case, it would be beneficial to have these references for your own records and review.
The Rule of Coding
Service codes define “what” you’re doing; diagnosis codes define “why” you’re doing it. The rules of thumb for coding any procedure or supply include three simple factors:
1. The CPT/HCPCS code selection must be that which most closely defines the service or supply provided.
2. An appropriate ICD-10 code must be assigned to support the service(s) or products provided.
3. Patient documentation must validate and support code selections.
Coverage and Benefits
Coverage for laser, as with any other service rendered, is strictly dependent on the coverage and benefits for individual patient policies.
Though it is often overlooked, the actual payer policies also outline specific covered and noncovered services for that payer as a whole. Providers should be aware that some states, as well as some individual payers, do specify which codes should be used for specific services. It is the provider’s responsibility to obtain this information and apply it as required. An annual review of payer policy and state guidelines would be considered a best practice to ensure that your practice maintains compliance with current policies. This serves as risk management on a number of levels, as well as a way to help the practice ensure it is properly paid for services rendered, where coverage is available.
As a reminder, Medicare does not cover laser therapy for chiropractic in any region.
Detailed Documentation
Anytime you are expecting a third-party payer to cover and allow charges or issue reimbursement for a service rendered, you must have complete documentation. Billing for laser therapy is no exception to the rule. The following information will describe what must be documented specifically for laser therapy services:
• Supporting medical necessity for the treatment rendered according to the standard definition of medical necessity.
• Reason or purpose for performing this service (this is your diagnosis).
• Duration of laser therapy.
• Region(s) of the body to which laser therapy was provided.
• Doctor observations or new findings during or after laser therapy (as applicable).
• Demonstration of change (improvement or lack thereof) in the patient’s condition and symptoms as he or she progresses through care, including clearly identifying specific functional changes recognized by the provider or noted by the patient.
Importantly, if your practice has established laser therapy as a cash-only service or for cash-paying patients, please take note that documentation guidelines still apply to you. The one item that really differs in documentation from a cash-paying patient versus a patient for whom a third-party payer is responsible is the medical necessity component. As a cash-type service or for maintenance therapy, medical necessity criteria may often not be fully established in documentation. All other elements of documentation that describe what, why, where, how, and how long (for timed services) a service is being provided are required.
Proper Code Selection
Once you have confidently identified the type of instrument you have, you are then able to evaluate code options to determine which is most applicable. Let’s look at coding options for your better understanding.
S8948 - Application of a modality (requiring constant provider attendance) to one or more areas; low level laser/cold laser; each 15 minutes
Keep in mind that laser is often performed in less than 15 minutes, and the AMA requires a full unit of the service to be performed in order to be billable to a third party. Most payers accept CMS timed services guidelines, which indicate that a minimum of eight minutes of service can qualify as one full unit.
Since this code requires constant provider attendance, you must know how this is defined by your state if anyone other than the provider performs laser therapy in your practice.
97039 - Unlisted modality (specify type and time) 97139 - Unlisted therapeutic procedure (specify)
Codes 97039 or 97139 are appropriate for use with LED, low-level/cold laser in which less than one full unit of service was rendered and hot lasers (such as some class III and many class IV lasers). Code 97039 typically is recommended in these instances due to these procedures being more commonly defined as modalities.
97026 - Application of a modality to 1 or more areas; infrared
Code 97026 is for use only with infrared units and not to be mistaken with laser therapy or LED. Infrared is defined as a modality that uses light and heat to increase tissue temperature 5 to 10 degrees centigrade in the area of application. If the code description and requirements are properly met, the class III and class IV hot lasers or other hot lasers may qualify for use of 97026, but you would need to verify infrared capabilities with the manufacturer.
Modifier GP - Services delivered under an outpatient physical therapy plan of care
The GP modifier is required to append to outpatient therapies for government payers, including Medicare. Standard major medical payers often also require the GP modifier to be appended to outpatient therapy procedures.
Lastly, when selecting codes, consider the circumstances for which laser therapy is being performed. Recognize that laser therapy is, in fact, often performed in conjunction with another treatment, such as an active therapy. As such, while unrelated to laser therapy, should you perform another type of therapy or treatment (including but not limited to therapeutic exercises - 97110, or therapeutic activities - 97530), this additional and separate treatment/therapy also is likely billable, provided that medical necessity guidelines have been met and the procedure is properly documented and supported.
Brandy Brimhall CPC, CMCO, CCCPC, CPCO, CPMA has served chiropractic since 1999. She holds multiple certifications in the areas of coding, compliance and auditing. She has a passion for serving practices by helping them obtain information, understand rules and regulations and streamline their practice systems. Brandy serves chiropractic as your Virtual Chiropractic Assistant with CHelpDesk Solutions (www.CHelpDesk.com).
