Doctors with Questions

Selection of Billing Codes:

According to the AMA Coding Rules, the equipment is not billed for use in office. Billing for the Wobble Chair™, Cervical Traction Unit™, Fulcrums, or Pettibon Body Weighting System™ is not appropriate. Rather, the therapeutic goal determines the code.

For example, the wobble chair can be used to build muscle strength and endurance, ROM and flexibility. That is the definition of therapeutic procedure (97110). However, if you were to use the wobble chair to improve movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities then the correct code would be NMR (97112).
These codes are for 1-on-1 time (15 minutes per billable unit) with the physician or therapist. If you are not 1-on-1 then the code would be group therapeutic procedure (97150), which pays a bit less but is the more correct code. It is the measurable goal that determines the code not the equipment.

According to CPT® guidelines, mechanical traction (97012) is described as “the force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction are intermittent or static (describing the length of time traction is applied), or auto-traction (use of the body’s own weight to create the force).” This code may be billed for use of the PTLMS since it certainly “creates a degree of tension of soft tissues”. Others have chosen to use manual therapy (97140) for accomplishing lymphatic drainage or massage (97124) since the action of the PTLMS itself is percussion.

Again, the code is based on the documentation of the goal of the procedure.

*DISCLAIMER: CPT codes are subject to change without notice. Check your state law and/or a billing professional in your area. The codes described here are not guarantee of payment, even with proper documentation. Improper use of codes will likely get you in legal trouble (maybe jail) and owing a bunch of money to an insurance company.

Durable Medical Equipment:

1. When billing ANY equipment it is best to have a letter of medical necessity accompany the billing. This does not have to be long and drawn out. Simply state the patient’s problem that will be addressed with the specific equipment.

2. Send a copy of the page from the Pettibon catalog as a description of the equipment.

3. Specific coding:
a. Cervical Traction Unit – E0855 or E0860

b. “Positioning Cushion/Wedge” – E0190

4. Other equipment: We use E1399 which is “miscellaneous DME”. That is why it is so important to use the product catalog and letter of med necessity.

These are ONLY recommendations, codes change without notice. Please share any other trends you begin to experience.

Yes Dr. Taggart I have both kinds. From a practical standpoint, the advantage of the PSRT is that you can achieve a good amount of distraction in a much shorter time frame than with conventional decompression, which has to wait for the muscles to relax before increasing pull is initiated. The PSRT table is based upon the idea that vibration frequencies cause the joint musculature to fatigue and relax, thus not being able to resist the traction effect. This is similar to when vibration is introduced to the neck of a torticollis patient and the neck immediately straightens up. Since the patient receives the benefit of traction on the white tissue from the moment the vibration is turned on, there doesn’t have to be any “down time” so to speak, so patients can perform PSRT therapy for 4-10 minutes and get the response of doing 20 minutes on a conventional table.

Hi Mike,

I currently have both tables. After this weekend’s seminar, thanks Shan, I am using the PSRT much more effectively (pulse oximeter monitoring) and am watching people respond faster than they ever did on the pull-release type. Beyond that- I don’t think I could add anything to what Mark or Shan stated.

See above. Same response as M Battson on April 2, 2010

Sharon Pettibon actually will mentor/coach doctors who would like some help designing their office layout and flow. On the Pettibon System website, there is a link with a questionnaire for you to fill out and submit. You can find the link at: http://www.pettibonsystem.com/services/index.php.

Where and how to start is based on what you want to accomplish. We regularly work with doctors who are going for financing to work up a budget for the equipment in their clinic. Some outfit the full practice and others are augmenting an existing practice. My suggestion is to complete the questionnaire from the website and send it in for review. If you’d like to have a quick chat, open to that too. 888-774-6258 Miriam Battson – The Pettibon System

I recently attended the rehab seminar in Newark with Dr. Shan Hager. It was really great but I have a couple blank spots in my notes. If I find a right cerbellar and left cerebrum problem, where will I place the headweight first in order to begin neurolgic correction?

thanks
kevin

Thanks Dr. Shan. Really, I learned a ton. And rest assured, I will be taking the neurology seminar next year. But of course I have two questions first related to the stress xray. Should the patient be head weighted for their lateral misalignments or should the first stress xray exclusively target correcting FHP? If only FHP first, what percent correction before lateral weighting? There are varying answers written in the online material. Second, headweighting for the stress xray causes some raising of the hard pallate. What does this indicate and what do I do about it?

Thanks again, Kevin

Great question. The Therapeutic Wobble Chair, Repetitive Cervical Traction and Thoracic Roll are all part of the pretreatment rehab prior to the decompression traction. Additionally, the patient wobbles, does cervical traction after the decompression therapy. Finally, weighting is typically a post treatment rehab procedure to strengthen involuntary postural muscles.