Denial For Hot/cold Packs

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6
Location
Munster, IN
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We're getting denials for 97010 (hot/cold packs) provided during a PT session by and IL WC carrier. The WC ins states that due to NCCI bundling edits, they are not separately payable. When I asked them to show me where they found this info, they could not lead me to it. Does anyone out there know if hot/cold packs are included in the bundling edits?
 
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114
Location
Madison Area Chapter in Madison WI
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The application of hot/cold packs are included in all other services per Medicare's payment policies. They have been given a "B" status, which means they are bundled with other services.

You can also find the policy that specifically addresses PT on the WPS Medicare website, in the PHYSMED 009. I think it's section IV.

The logic is that the application of hot/cold packs doesn't require enough "work" to support additional reimbursement, so it is considered incidental.
 
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6
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Munster, IN
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for medicare beneficiaries and federal WC i do know that they are bundled. but for IL WC, we are paid by every other WC carrier except this one because they are trying to use medicare as the standard. however, i'm wondering if anyone out there specifically knows if they're considered bundled for IL WC? the IL WC Commission website just references the NCCI, which does not state that these cannot be billed separately.
 
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114
Location
Madison Area Chapter in Madison WI
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Good question. Most carriers, including commercial or worker's comp, look to what see Medicare is doing to determine their own policies. Some may pay for hot/cold packs, but they are not required to do so unless it is specifically written into their coverage or contract policies.
 
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Hot/Cold packs

I work for a company that does wc bill reviews. We allow one hot/cold pack per session. When billing hot/cold pack with e-stim be sure you are not doing these simutaneoulsy(sp?) or one will probably get denied. The rational is that you are doing both within the same time frame therefore not seperate. Billing as one unit (15 min). You must document that you did these seperatly. Remember Medicare is only a guideline for IL WC FS. The only thing our commission has said is that it has adopted the NCCI into the schedule. These are not medicare claims. Hope this helps.

Anita Carleton, CPC
 
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