Therapy Clinic Billing for Lymphedema Therapy

As a specialty therapy clinic, billing can be difficult to find specifics that relate to billing when researching CPT codes to achieve maximum reimbursement on your claims. This article will give a little insight into Lymphedema billing practices that will have a positive impact on your bottom line.

Evaluation Codes

On January 1^st, 2017 the CPT (Current Procedural Terminology) guidelines for evaluation codes changed to incorporate complexity levels. This change does not currently affect the reimbursement. However, down the road, it may be necessary to understand what your notes convey about your patient treatment. PT’s and OT’s should stop using 97001 (PT eval), 97002 (PT re-eval), 97003 (OT eval) and 97004 (OT re-eval). Utilize these current codes:

97161 – PT Low-complexity eval

97162 – PT Moderate-complexity eval

97163 – PT High-complexity eval

97164 – PT Re-Evaluation

97165 – OT Low-complexity eval

97166 – OT Moderate-complexity eval

97167 – OT High-complexity eval

97168 – OT Re-Evaluation

Self-Care Billing

Oftentimes, therapists intend to instruct a patient on how to care for themselves at home during their timed treatment. CPT code 97535 is one of the codes that need to be utilized properly in order to be compensated. First, when performing authorizations, be sure to ask the payer specifically if this code is covered. If they tell you it isn’t, include the education time in your direct patient contact time on usual therapeutic CPT codes. But, if they state that the code is covered, use 97535 to instruct on performance of compression and garment instruction in addition to therapeutic billing. Always document what you taught and plan on having to appeal for some claims even if specifically informed that it is a covered billable item.

Compression Billing

Compression CPT codes 29581-29584 are also payer-specific and need to be addressed at the time of verification. These codes are per-treatment codes that you should bill with one unit. If you perform compression during the same session as manual therapy, append a 59 modifier to the 97140 CPT. You also need a modifier if you treat more than one body on the same day. If the patient has compression on both legs below the knee, you can either:

1. use 29581 with two units and append a 50 modifer to indicate bilatera, or
2. bill one unit of 29581 twice, one with a RT(right) modifier and the other line item with a LT(left) modifier.

Little by Little

We will continue to research and provide relevant billing information for specific therapy billing requirements. Each code has its own interpretation. Learning those definitions and comparing to your therapy practices may provide small increments of payment increases.

For example, for Lymphedema, there are always questions regarding compression pumps. We encourage you to follow the CMS links to find out more. Compression garments are not a covered item under Medicare guidelines. You can bill compression garments to the patient without an ABN (Advanced Beneficiary Notice).