Date: Thu, 20 Feb 97 23:26:03 UT From: "DR. FRANK PAINTER" Subject: DESCRIPTION OF SERVICES Subject: DESCRIPTION OF SERVICES Hi Listers, When I send out billings I occasionally add notes describing what the CPT codes are. Sort of my own EOB (Explanation of benefits). I thought there might be some interest in seeing them. They were developed before '97, so it doesn't have the new CMT codes in it yet. Some other things may need to be dropped as well. I'll do it before the 3 month "grace period" ends. I hope you may find them of use in your practice. I suspect more insurers will demand this type of explanation (rationale) of why you supply a service in the future. That's why I wrote them like I did. Frank M. Painter, D.C. --------------- DESCRIPTION OF SERVICES: DATE CPT CODE SERVICE PURPOSE 2-20-97 99202 Expanded New Patient Exam This is a thorough exam of a region, including history and clinical decision making, and may involve counseling and/or coordinating with other care givers. This involves a minimum of 20 minutes face to face between the doctor and patient. 99203 Detailed New Patient Exam This is a thorough exam of one or two regions, including the history and clinical decision making, and may involve counseling and/or coordinating with other care givers. This involves a minimum of 30 minutes face to face between the doctor and patient. 99204 Comprehensive New Patient Exam This is a thorough exam of one or two regions, including the history and clinical decision making, and may involve counseling and/or coordinating with other care givers. This involves a minimum of 45 minutes face to face between the doctor and patient. 99211 Typical Established Patient Visit This standard office visit includes evaluation and management components of care, which include a thorough exam of a region, including history and clinical decision making, and may involve counseling and/or coordinating with other care givers. This involves a minimum of 10 minutes face to face between the Doctor and Patient. 99212 Focused Established Patient Re-exam This is a thorough re-exam of a region, including history and clinical decision making, and may involve counseling and/or coordinating with other care givers. We re-evaluate patients on their 12th visit to determine progress, changes in symptoms and positive orthopedic tests, muscle strength, trigger points or postural improvements. This data is used to modify care plans appropriately as patient's needs change. This involves a minimum of 15 minutes face to face between the doctor and patient. 99213 Expanded Established Patient Re-exam This is a thorough re-exam of a region, including history and clinical decision making, and may involve counseling and/or coordinating with other care givers. We re-evaluate patients on their 12th visit to determine progress, changes in symptoms and positive orthopedic tests, muscle strength, trigger points or postural improvements. This data is used to modify care plans appropriately as patient's needs change. This involves a minimum of 20 minutes face to face between the doctor and patient. 99214 Detailed Established Patient Re-exam This is a thorough re-exam of a region, including history and clinical decision making, and may involve counseling and/or coordinating with other care givers. We re-evaluate patients on their 12th visit to determine progress, changes in symptoms and positive orthopedic tests, muscle strength, trigger points or postural improvements. This data is used to modify care plans appropriately as patient's needs change. 99212 Focused Report of Findings After an exam (or re-exam) the patient must be advised of the findings of that exam, the changes in their condition, the modifications that will be made in the care plan, and the expected outcome. Other counseling on changes in the patient's activities of daily living may be given. This involves a minimum of 20 minutes face to face between the doctor and patient. 99213 Expanded Report of Findings After an exam (or re-exam) the patient must be advised of the findings of that exam, the changes in their condition, the modifications that will be made in the care plan, and the expected outcome. Other counseling on changes in the patient's activities of daily living may be given. This involves a minimum of 25 minutes face to face between the doctor and patient. 97260 Spinal Adjustment, one area This is a spinal adjustment of the Vertebral Subluxation Complex of one region. 95831 Muscle Testing-Manual Extremity/Trunk Muscle strength imbalances contribute to unequal loading of joints and lead to instability, damage and degenerative changes in the connective tissue. See attached report 97265 Joint Mobilization The goal of the use of joint mobilization is the restoration of optimal athrokinematics. Movement into resistance free, pain free range is utilized to treat symptoms related to a loss of normal (functional) movement in one or more joint structures. E0230 Gel Pack Icing instructions are given to patients along with the Gel Pack in order to reduce pain and swelling associated with injuries or inflamed areas. Reduction of inflammation is the first step in reducing excessive formation of scar tissue. This reduces the likelihood of residual disability for the patient. L0120 Cervical Collar When a patient has strained or sprained their neck, a support collar is necessary for the first 1-2 weeks. Strained muscles cannot "guard" the delicate neck. The collar adds that missing support to prevent further ligamentous injury. E0943 Cervical Pillow If a patient has a loss of cervical curve (hyperlordosis), we prescribe a supportive cervical pillow to reinforce the care in the office. A4556 Large EMS Pads Disposable self-adhering pads are supplied to the patient for certain electrotherapies. These are re-usable and often last the patient through the period of time they require a therapy. These pads are what conduct the modality to the patient's skin and are necessary to receive the modality. 97010 Cryotherapy/ Moist Heat Cryotherapy is applied to reduce pain, swelling (edema) and congestion as well as to reduce the inflammatory process for the purpose of reducing residual scar tissue formation. Moist heat is applied to relieve pain, relax musculature and to improve lymph drainage in the region of complaint. 97035 Ultrasound This therapy is used to deep heat tissues to increase protein production at the site of injury, and to increase elasticity of the new collagen fibers being laid down. It may also be used at "pulsed" levels (20%) to move fluids away from an inflamed region. This involves 11 minutes for therapy and cleanup. 97032 Electric Stim/Manual This is a combination of Ultrasound and High Volt DC electrotherapy, which is used to reduce pain, edema and congestion in a newly injured or inflamed region. Reduction of this component of the inflammatory reaction reduces the likelihood of residual impairment through excessive scar formation. This involves 13 minutes for therapy and cleanup. 97014 Electric Stim Unattended This is either High Volt DC Current, used to reduce edema, muscle spasm or pain, OR it is Interferential Current used to reduce pain and muscle spasm. This involves up to 15 minutes for therapy and cleanup. Please note that 1995 CPT codes describe this as a 15 minute procedure, so that a ½ hour treatment must be described as 2 units. The old code for "Additional treatment to 2nd area or additional 15 minutes" (CPT 97145) has been deleted. 97250 Myofascial Release This is a soft tissue mobilization, used to reduce "trigger points" (TrP) in muscle and fascia by using ischemic compression and other techniques. The TrP is a painful band or "knot" in a muscle, formed by injury or by repetitive microtrauma. Most TrP's resolve in 4-7 treatments. Resistant TrP's can take 10 or more visits. This involves 12-15 minutes with the doctor. 97124 Massage Massage, which includes effleurage, petrissage and/or tapotement, may be prescribed for a patient after an acute soft tissue injury or an exacerbation of symptoms to prevent and/or reduce edema, muscle spasm and pain. It also stimulates lymph drainage, which removes metabolites, which may contribute to excess scar formation. In a patient with pneumonia or other respiratory congestive disease, it promotes drainage of the lungs and breaks up congestion. NOTE: 1995 CPT Codes have been modified from "initial 30 minutes" to "each 15 minutes", so please check for the number of UNITS billed; each unit is 15 minutes. Rehabilitation Prescription Mr./Ms. has been diagnosed with biomechanical and structural instabilities that directly contribute to his/her symptoms. A prescription for a managed care rehabilitative exercise program, utilizing resistance tubing devices and other equipment, has been made. The purpose of this program is to provide a low resistance and high repetition workout, leading to gradual strengthening of the (___) region's muscles and ligaments. This program is specifically designed to relieve pain, increase capillary action, loosen adhesions, and to increase the structural strength and stability of the region of complaint. This program involves Kinetic Activity (97530) and Therapeutic Exercises (97110), both for 15 minutes under direct supervision of the Doctor. 97530 Therapeutic Activity This is the beginning of our rehabilitation process. We do active and/or passive range of motion (ROM), active muscle stretches and/or resisted isometric stretches for 15 minutes. The purpose of this is to stretch the collagen tissue which is being laid down during the healing process. This will improve the strength and elasticity of the new "scar" tissue and improves functional performance. 97110 Therapeutic Exercises The patient does resistive exercises to develop strength and endurance, range of motion and flexibility, which all lead to stability of the spine. This program is specific to the injured tissues, as well as to the regional musculature. This is a 15 minute program. 97112 Neuromuscular Reeducation Various techniques are utilized to reeducate patterns of movement, balance, coordination, kinesthetic sense, posture, and proprioception. This is a 15 minute program. 76140 Consultation on X-rays Made Elsewhere Our x-rays are taken at Westgate Orthopaedics in Oak Park. No radiologist sees the films. They are brought directly to my office by the patient. As a primary care doctor, I am licensed by Illinois to read (order and take) my own films. A radiologist generally only notes fractures and soft tissue pathology on their reports. When I receive the films, I review them for the pathology, as well as to diagnose all the biomechanical aberrations found on all views. This is the basis of chiropractic. I then have to write my own report, noting the above. This is my legal duty as the doctor ordering the films. The charge is for the professional component of my service. 76140 Consultation on X-rays Made Elsewhere Our x-rays are read by a medical radiologist at the hospital they were taken at. They will not release the films to us without this reading, even after being asked to forgo the reading and extra charges on the basis that I am licensed by Illinois to order, take and read my own films. The radiologist only notes fractures and soft tissue pathology. When I receive the films, I must still review them for the above, as well as for all the biomechanical aberrations on the "stress" views. I then have to write my own report, noting the above, along with whatever things the radiologist fails to observe. This is my legal duty as the doctor ordering the films. The charge is for the professional component of my service. A9300 BackSys Home Unit To compliment the rehabilitation program, the patient is provided a home unit to do the exercises and postural modifications at home between visits. When the patient is here, we do the exercises, as well as checking to see that the patient is doing the procedures correctly and we also check for improvement. A9300 Theraciser Home Unit To compliment the rehabilitation program, the patient is provided a home unit to do the exercises and postural modifications at home between visits. When the patient is here, we do the exercises, as well as checking to see that the patient is doing the procedures correctly and we also check for improvement. 99002 Casting of Orthotic and Paperwork Handling If the patient has a postural distortion, flat feet or a short leg, we prescribe orthotics to correct the pedal imbalance in the patient. It has been found to support the care we give, as well as adding to the patient's personal comfort. Pes Planus is highly associated with development of heel spurs and knee and hip pathology, so prescription of the orthotic is very important in the prevention of these debilitating conditions. Casting and paperwork takes 10 minutes. L3020 Cost of Orthotic The charges for this shoe orthotic is exactly what FootLevelers charges us with no markup added. If the patient has a postural distortion, flat feet or a short leg, we prescribe orthotics to correct the pedal imbalance in the patient. It has been found to support the care we give, as well as adding to the patient's personal comfort. Pes Planus is highly associated with development of heel spurs and knee and hip pathology, so prescription of the orthotic is very important in the prevention of these debilitating conditions. 97703 Checkout for orthotic use, Established Patient. This describes components of an office visit in which a patient receives orthotics and training on activities of daily living (exercises and methods to increase mobility of the foot bones are demonstrated to the patient). This is an appropriate E/M code for the description of the professional component of the doctor's work, because there is significantly more work involved than with the usual 99211 office visit. 99054 Services requested on Sundays in addition to basic service. Early in an acute care plan it may be necessary to see the patient daily. If the patient requests service over the weekend (we are open 6 days a week), and we determine that service is medically necessary for the patient in their present condition, we will give care on Sunday. 72050 Radiologic examination, spine, cervical, 5 views. This is the routine cervical series with flexion and extension views included for biomechanical analysis. The cervical spine may lose the "coupled motion", which permits it to move and function so freely. This loss of function leads to pain, muscle spasm and degeneration of the vertebral discs and posterior joints. Research has shown that loss of this coupled motion is key to loss of function of the spine, and that "stress" views in full flexion and extension are the most effective way to document and locate the segments of the spine that have lost their normal function. Manipulation is the ONLY documented treatment known to restore lost function and to reduce the symptoms at the same time, as described in the AHCPR Federal Guidelines released 12-8-94. 72110 Radiologic examination, spine, lumbar, 5 views. This is the routine lumbar series with lateral bending views included for biomechanical analysis. The lumbar spine may lose the "coupled motion", which permits it to move and function so freely. This loss of function leads to pain, muscle spasm and degeneration of the vertebral discs and posterior joints. Research has shown that loss of this coupled motion is key to loss of function of the spine, and that "stress" views are the most effective way to document and locate the segments of the spine that have lost their coupled motion. Manipulation is the ONLY documented treatment known to restore lost function and to reduce the symptoms at the same time, as described in the AHCPR Federal Guidelines released 12-8-94. 99080 Records Copy and Transfer Illinois Statute Ch. 110. Par. 8-2003 describes the right of Insurance Companies to receive medical records AND describes the right of the Doctor to be paid for this effort. 99080 Initial (or Progress) Insurance Narrative CPT 96 describes this as a "special report(s) such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form" This is a required written Initial (or Progress) Report sent to insurance adjustors/lawyers etc. to describe the patient's present complaints, our exam findings, diagnosis, care recommendations and prognosis (when known). This is MORE than a standard reporting form, which is commonly a check-list. 97750 Physical Performance Test or Measurement CPT 95 deleted 97720 (Muscle testing) and now requires the use of this code for reporting of musculoskeletal or functional capacity testing. SOAP Notes as above and/or a Test Report are included for the required report. 99371 Telephone Call/ Medical Management When a referral to a consulting doctor is made, often a lengthy verbal description of the patients condition and progress is necessary for the second doctor. 99080 Progress Narrative Report When a consultation for additional testing and a second opinion is sought, it is protocol to prepare a lengthy narrative to bring the second doctor up to date. This is necessary for the doctor to understand the patient's history and present condition and likely outcome. --------------------