Part B Insider (Multispecialty) Coding Alert

Published on Tue Apr 04, 2006 PDF

You can bill for training on the same day as an orthotic/prosthetic checkout

If your physician or other provider is helping patients cope with orthotic or prosthetic devices, you'll have three new codes to cope with.

CPT 2006 introduced orthotic management and training code 97760, prosthetic training and management code 97761, and orthotic/prosthetic checkout code 97762. These codes replace similar codes that were scattered in the CPT book last year, says Mary Lou Martin, a consultant with Skoda Minotti & Co. in Mayfield Village, OH.

Typically, you use 97760 for training a patient on using an orthosis, including advising the patient on looking out for skin problems and fitting issues, and teaching "little exercises to do at home," says Martin. And CPT 97761 is similar to 97760, except it's for prosthetics instead of orthotics.

You'd use 97762 for an existing orthotic or prosthetic, explains Martin. The patient may need a checkup to see if there's any redness or rash or other symptoms that might warrant a minor adjustment.

You'd use the "rule of eight" to bill for each of these codes, because they count in 15-minute intervals. The "rule of eight" says the first 15-minute unit starts after eight minutes of treatment and goes until 23 minutes. The second 15-minute unit runs from 23 to 38 minutes, and so on.

Best practice: The provider should note the start and end time of treatment instead of just the total time spent with the patient, Martin advises. Your provider should list exactly what he or she did, including any training or skin care tips.

CPT says: You shouldn't report 97760 along with gait training code 97116, Martin points out. However, the CPT Assistant for December 2005 says you may be able to bill therapeutic procedure code 97110 in addition to 97760, she notes.

Example: A patient has a nerve injury secondary to a fracture of the humerus. The provider may instruct the patient in upper-extremity strengthening exercises, in addition to training the patient on the use of an orthotic. The provider can bill 97110 for the strengthening exercises.

You can also bill for the appropriate "L" code for the orthotic or prosthetic device if your office provides it directly, Martin adds. If a durable medical equipment supplier provides the orthotic or prosthetic, then you wouldn't bill the "L" code, and you wouldn't bill for any fitting or measurements that the DME provider performed.

Note: You can bill 97760 and 97762 on the same date of service, Martin says. When a patient comes in for a checkup on an existing orthotic device, the patient may turn out to need additional training. In that case, you bill 97762 for the checkup and 97760 for the extra training.