Part B Insider (Multispecialty) Coding Alert

Published on Mon Sep 11, 2006 PDF

Helpful hint:  Double-check your Medicare carrier's coverage guidelines for each.

If you report 97166, 97799 or 95999 for gait analysis, you are walking straight into a denial.

Reason: The BCBS Montana Medicare Local Coverage Determination is typical of many carrier determinations when it states: "Gait analysis performed as a diagnostic test is considered inclusive in the E/M service and not separately payable. It should not be coded or billed as 97116 (Therapeutic procedure, one or more areas, each 15 minutes; gait training [including stair climbing]), 97799 (Unlisted physical medicine/rehabilitation service or procedure), or 95999 (Unlisted neurological or neuromuscular diagnostic procedure)." These codes are often incorrectly used to bill for gait analysis services.

The right way: Report gait analysis using only five codes: 96000-96004. The first four are lab test codes, and you can report more than one of these codes at the same time, depending on the tests the lab performs:

• 96000--(Comprehensive computer-based motion analysis...)

• 96001--(...with dynamic plantar pressure measurements during walking)

• 96002--(Dynamic surface electromyography...)

• 96003--(Dynamic fine wire electromyography...)

• 96004 (Physician review and interpretation...with written report)

You should report 96004 when the doctor reviews the test results and provides a written report.

Don't forget: Make sure you link your CPT codes to a diagnosis code on your Medicare carrier's list of diagnoses that prove medical necessity for gait testing--such as cerebral palsy, spina bifida or hemiplagia.

Tip: Before performing a gait analysis, check with Medicare to make sure the service is covered, suggests podiatry biller Tempie G. with Professional Coding Connection in Virginia Beach,  VA. Checking with your carrier is important because there may be certain circumstances under which it may cover gait analysis even if it normally denies coverage.