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2014 Cold Laser Guide Compare Cold Lasers

ColdLasers.org makes no guaranty regarding reimbursement from insurers and no guarantees with respect to appropriate diagnosis and/or procedure codes for insurance billing and reimbursement codes.

International Classification of Diseases, Clinical Modification, 10th Revision (ICD-10-CM)

According to the Centers for Disease Control, the ICD-10-CM "is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States." These codes are used in billing and reimbursement for medical diagnoses and procedures.

Cold laser or Low-Level Laser Therapy (LLTT) is used to treat a variety of medical conditions. The following list of diagnoses may be appropriate for cold laser therapy. Please consult your doctor or the ICD-10-CM TABULAR LIST of DISEASES and INJURIES available on cdc.gov.

Suggested Clinical Uses for Cold Laser Therapy:

INFLAMMATORY CONDITIONS

  • Rheumatoid Arthritis
  • Epicondylitis
  • Carpal Tunnel Syndrome
  • Bursitis
  • Plantar Fasciitis

Primary Diagnosis

  1. Pain
  2. Restricted range of movement/stiffness
  3. Edema
  4. Effusion
  5. Paresthesia
  6. Inflammation
  7. Adicular pain
  8. Muscle spasms
  9. Myofasciitis

PAIN MANAGEMENT

  • Fibromyalgia
  • Bursitis
  • Lower back pain
  • Myofascial pain
  • Fasciitis
  • Neck/Cervical pain

Primary Diagnosis

  1. Pain
  2. Restricted range of motion/stiffness
  3. Inflammation
  4. Effusion
  5. Edema
  6. Muscle spasms
  7. Mysofasciitis

CONNECTIVE TISSUE INJURY

  • Tendonitis
  • Tendon ruptures
  • Sprains
  • Strains

Primary Diagnosis

  1. Pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Effusion
  5. Edema
  6. Muscle spasms
  7. Myofasciitis
  8. Radicular pain

JOINT INJURY

Temporomandibular (TM) disorders

  • Ligament injury
  • Dislocations
  • Osteoarthritis

Primary Diagnosis

  1. Joint pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Joint effusion
  5. Edema

MUSCLE INJURY

  • Muscle bruises/contusions
  • Muscle contractures
  • Muscle ruptures
  • Myositis

Primary Diagnosis

  1. Muscle Pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Muscle spasms
  5. Edema
  6. Myofasciitis

NEUROLOGICAL INJURY

  • Ruptured disc
  • Prolapsed disc
  • Crush injuries
  • Neuritis

Primary Diagnosis

  1. Radicular pain
  2. Myofasciitis
  3. Decreased range of motion/stiffness
  4. Inflammation
  5. Muscle spasms
  6. Paresthesia
  7. Edema
  8. Effusion

SKIN INJURIES AND CONDITIONS

  • Burns
  • Skin ulcers
  • Skin grafts
  • Surgical incisions
Primary Diagnosis
  1. Joint pain
  2. Inflammation
  3. Restricted range of motion/stiffness
  4. Edema

Current Procedural Terminology:

The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association and is "the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs."

After a diagnosis is made and an appropriate code is assigned (see above), insurance billing is made under a particular CPT code.

Because cold laser or LLLT does not have its own CPT codes, the following codes are being used for reimbursement:

97039 Physical Medicine and Rehabilitation; constant attendance unlisted modality; 15 minutes

For billing, this code should be accompanied by a one-page description of the treatment and the therapy. Otherwise, it may be denied. When you submit the code, try this: "97039 Attended FDA cleared infrared laser therapy." 97140 Manual Therapy Techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction); one or more regions; each 15 minutes. This billing code is used for what you are doing and/or accomplishing, not the technique used (i.e. laser). If an insurance carrier requires documentation, state what area was treated and what was accomplished (i.e. drainage, mobilization, etc.).

97026 Infrared

This code refers to an infrared heat lamp, but cold lasers are not infrared heating devices. Consequently, reimbursement can be low. To improve reimbursement, list as an attended modality or by adding a -22. Here are some examples:

97026: Attended photonic simulation

97026: Attended infrared light therapy

97026--22: Attended infrared therapy

97032 Attended Electrical Stimulation; manual; one or more regions; each 15 minutes

This code can be billed in a number of ways. The code (97032) stays the same, but the description changes to reflect the service performed. For example:

97032: Attended Electrical-Photonic Stimulation

97032: Attended Electrotherapy/IR

97032: FDA-Cleared Laser Photonic Stimulation

97139 Unlisted Therapeutic Procedure
This code is for a therapeutic procedure meaning that the doctor must have one-on-one contact with the patient. The strength of the code is that it tells the insurance carrier that the doctor is spending direct treatment time with the patient. The weakness of the code is that an unlisted procedure is more likely to be closely inspected by an insurance carrier.

97112 Neuromuscular Re-Education and Gait Training (movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting or standing activities); constant attendence; each 15 minutes

97799 Physical Medicine and Rehabilitation‚??Unlisted Service or Procedure (requires documentation, fees negotiated)

97901 Acupuncture Modality

**Please note that CPT codes ending in "9" require documentation. For example, 97039-FDA-Cleared Laser Therapy. Additional documentation explaining the therapy may also be required.

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