Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Discussion
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 01-15-2009, 06:23 AM
dballard2004 dballard2004 is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,143
dballard2004 is on a distinguished road
Default Prolotherapy

Does anyone have any info on how to code properly for prolotherapy? What CPT codes do we use? Thanks.
__________________
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P
Coder

Last edited by dballard2004; 01-15-2009 at 09:20 AM.
Reply With Quote
  #2  
Old 01-15-2009, 06:58 AM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default

For Medicare purposes, you would report M0076; although, I don't think Medicare reimburses for this. I have seen other offices submit 20550 for the other carriers.


Ok...found Medicare's policy. The policy is in alpha order once you open the link.

"The medical effectiveness of the above therapies has not been verified by scientifically controlled studies. Accordingly, reimbursement for these modalities should be denied on the ground that they are not reasonable and necessary as required by §1862(a)(1) of the Act."

http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd

Last edited by RebeccaWoodward*; 01-15-2009 at 07:06 AM.
Reply With Quote
  #3  
Old 01-15-2009, 09:22 AM
dballard2004 dballard2004 is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,143
dballard2004 is on a distinguished road
Default

Thanks. We were wondering if we could even bill this or not. I have done some research on this that seems to indicate that this service is not covered but many plans. Thanks.
__________________
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P
Coder
Reply With Quote
  #4  
Old 01-15-2009, 12:43 PM
dballard2004 dballard2004 is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,143
dballard2004 is on a distinguished road
Default

One other question......is the code M0076 only for Medicare use or can we report this to commercial insurance. If Medicare does not cover this service, then why do they have a code for it?
__________________
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P
Coder
Reply With Quote
  #5  
Old 01-15-2009, 01:14 PM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default

1) I think this will become carrier specific. I looked at some of carriers and they do not accept M0076.

Aetna considers prolotherapy (also known as proliferant therapy or proliferation therapy) experimental and investigational for any indications because there is inadequate evidence of its effectiveness.

BCBSNC does not provide coverage for Prolotherapy because it is considered investigational. BCBSNC does not cover investigational services.

UHC-Coverage Rationale
The use of prolotherapy for any musculoskeletal indications such as chronic low back pain and osteoarthritis of the knee, thumb, and finger joints is unproven due to inadequate clinical evidence of safety and/or efficacy in published peer-reviewed medical literature.

2) As for Medicare, sounds like to me it's for reporting purposes yet it allows the provider to invoice the patient with a completed ABN. I look at this way...UHC doesn't pay for the XSTOP procedure (0171T). They recognize it but they consider it experimental; yet they do allow the provider to bill the patient with proper notification. M0076 is recognized by Medicare but not proven to be effective.

Anyone else?
Reply With Quote
  #6  
Old 01-15-2009, 01:46 PM
dballard2004 dballard2004 is offline
True Blue
 
Join Date: Apr 2007
Posts: 1,143
dballard2004 is on a distinguished road
Default

Thanks so vey much!
__________________
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P
Coder
Reply With Quote
  #7  
Old 11-10-2010, 10:33 AM
bebe bebe is offline
New
 
Join Date: Apr 2007
Posts: 1
bebe is on a distinguished road
Default Livi Rizo, CPC

Our Doctor has been using this procedure on many of our patients, the majority of them work comp. I have been using the 20550. I'm not sure if this is correct. I believe this is like a trigger point injection...right?

Reply With Quote
  #8  
Old 11-10-2010, 02:21 PM
cmcgarry's Avatar
cmcgarry cmcgarry is offline
Expert
 
Join Date: Apr 2007
Location: Sioux Falls South Dakota
Posts: 358
cmcgarry is on a distinguished road
Default

Quote:
Originally Posted by bebe View Post
Our Doctor has been using this procedure on many of our patients, the majority of them work comp. I have been using the 20550. I'm not sure if this is correct. I believe this is like a trigger point injection...right?

Although Prolotherapy is a "series of trigger point injections", you should not use the trigger point injection codes to bill it; and since most work comp requires pre-approval for procedures, visits, etc, you should not be performing prolotherapy when you have approval for trigger point injections. Also, 20550 is not a trigger point injection but a tendon sheath or ligament injection. The codes for trigger point injections are 20552 and 20553.

The big difference is in what is injected. In prolotherapy, "proliferative" solutions are injected into various trigger points, to irritate or inflame the area and supposed induce the production of addition collagen, strengthening the area. Some of the solutions include phenol and morrhuate sodium. Trigger point injections, on the other hand, involve injecting a therapeutic agent such as Depo-Medrol.

The therapeutic efficacy of prolotherapy has not been established; evidence is only anecdotal so far.

I hope this helps,
__________________
Lucinda (Cindy) McGarry, CPC-P
Applications Specialist
Avera Health Plans
Education Office Sioux Falls SD Local Chapter
Past President Sioux Falls SD Local Chapter
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 03:55 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC