97016: Application of a Modality to One or More Areas; Vasopneumatic Devices

In this quick-reference guide to CPT code 97016, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors.

NOTE: CPT codes and guidelines can be revised over time. To avoid billing issues, be sure to stay current with annual coding updates and changes to payer guidelines.

About CPT Code 97016: Application of a Modality to One or More Areas; Vasopneumatic Devices

CPT code 97016 refers to the application of a modality to one or more areas using vasopneumatic devices. This procedure involves the use of devices that combine pneumatic compression with vascular massage to treat various musculoskeletal conditions.Here’s what chiropractors need to know about using CPT code 97016.

Category or Type of Service

CPT code 97016 falls under the category of Physical Medicine and Rehabilitation services. It specifically pertains to the application of modalities, which are therapeutic procedures used to treat musculoskeletal conditions.

Billing Interval

This code is typically billed per unit or session. The duration of the vasopneumatic device application session determines the number of units billed. Accurate documentation of the time spent on the procedure is essential to support billing.

When Should Chiropractors Use Code 97016?

Chiropractors should use CPT code 97016 for patient visits that meet the following criteria:

• The procedure involves the application of vasopneumatic devices.
• Vasopneumatic therapy is indicated for the patient's condition and treatment plan.

When Should Chiropractors Not Use This Code?

• Chiropractors should avoid using CPT code 97016 if vasopneumatic therapy is contraindicated or not clinically indicated for the patient's condition.
• It may not be advisable for chiropractors to use this code for new patients. While there are no explicit rules against it, many insurance providers require an established treatment history and demonstrated need for this treatment, which are difficult to establish on a first visit.

Which Modifiers Can Be Used With CPT Code 97016?

Common modifiers used with CPT code 97016 include:

• Modifier 59. Indicates that the procedure is distinct and separate from other services performed on the same day.
• Modifier 25. Used to indicate that a separately identifiable evaluation and management service was performed on the same day as the procedure.
• Modifier GP. Some payers (like UnitedHealthcare) require this modifier for services provided by chiropractors that fall within the scope of physical therapy. In rare cases, Medicare may cover specific chiropractic services when accompanied by the GP modifier, but such coverage is very limited.

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What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

When billing for CPT code 97016, adhere to the following guidelines:

• Documentation of time. Clearly document the duration of the vasopneumatic device application session to support billing for the appropriate number of units.
• Treatment area. Specify the areas of the body where vasopneumatic therapy was applied.
• Medical necessity. Provide a rationale for the use of vasopneumatic therapy based on the patient's condition and treatment plan.

What Are Common Mistakes Made Specific to CPT Code 97016?

Some common mistakes associated with CPT code 97016 include:

• Failing to document the duration of the vasopneumatic device application session accurately
• Using this code for conditions or treatments not indicated for vasopneumatic therapy
• A lack of documentation to support the medical necessity of the procedure
• Not using the appropriate modifiers when warranted
• Incorrect coding for Medicare, as specific billing guidelines might apply

What Are Potential Audit Triggers Specific to This CPT Code?

Audit triggers related to CPT code 97016 may include:

• A sudden jump in the use of this code without a clear explanation
• Inaccuracies in the paperwork, most notably between documented time and billed units
• Lack of documentation to support the medical necessity of the procedure

Improve the Accuracy and Efficiency of Chiropractic Billing and Coding

To enhance billing and coding processes related to CPT code 97016, consider the following steps:

• Review proper documentation and coding procedures with staff.
• Check your work.
• Make sure you keep current with the latest payer guidelines and coding changes.
• Use a modern, integrated EHR and practice management software solution like ChiroTouch.

Streamline Coding and Billing with ChiroTouch

Managing a chiropractic practice involves dedicating time to coding and billing, yet choosing the optimal system can transform this aspect of your business from a burden to a powerful driver of success.

With ChiroTouch, you gain direct access to enhanced billing features, including automated claim submission, real-time eligibility checks, and streamlined payment processing.