Are you constantly getting denials for CPT code 97010? Stop billing it separately! Healthcare providers, especially therapists, often use therapeutic tools to help patients recover from surgeries, injuries, or chronic pain. The specific application of a hot or cold pack is represented by the 97010 CPT code. It seems simple, right?
But did you know that it is one of the most frequently denied physical medicine and rehabilitation modalities codes? The reason is simple! Many payers, including Medicare, rarely reimburse this code because they consider it bundled. This leaves even professional coders wondering whether they should bill it with a specific modifier or bundle it with a more comprehensive code. Our blog clarifies everything. Keep reading for a better understanding.
CPT Code 97010 – Description
CPT code 97010 refers to the application of a modality. But what exactly is a modality? A modality is a therapeutic agent, usually a physical one, expected to produce some sort of physiologic change or response when applied following a therapy.
So, what type of modality application does this code cover? As mentioned in the intro, the 97010 CPT code specifies the application of a hot or cold pack (ice pack) to one or more areas, at the provider’s discretion.
The primary purpose of using a hot pack is to improve the blood flow and reduce joint stiffness. On the other hand, a cold pack is useful for easing pain and reducing inflammation.
Scenarios Where CPT Code 97010 is Applicable
The following scenarios for CPT code 97010 can help reduce your billing confusion.
Using a Cold Pack After Closed Reduction of a Dislocated Shoulder
Shoulder dislocations are quite common, accounting for half of all major dislocations. In contact sports, they account for 67.3% of all injuries. Physical therapy, along with the application of a modality, is often the most popular post-treatment service for this injury.
So, for the first example of CPT code 97010, consider a 23-year-old NFL player in shoulder dislocation rehab. He attends multiple physical therapy sessions within a week to restore strength and flexibility. After an initial session, the therapist applies a cold pack to his shoulder to reduce inflammation and soreness. He then uses the 97010 CPT code to document the service.
Hot Pack Application for a Herniated Disk
Around 5 to 20 herniated disk cases per 1,000 adults are reported annually. Most of these people are in their 30s to 50s. Healthcare providers encourage physical therapy and the use of hot and cold packs to relieve pain and strengthen back muscles.
So, for this scenario, suppose a 35-year-old office worker develops a lumbar disk herniation due to prolonged shifts (12-hour shifts). He experiences persistent low-back pain, numbness and tingling in his thigh, and core muscle weakness. He visits a primary care physician who recommends physical therapy to relieve nerve pressure.
After a therapy session, the physical therapist applies a hot pack to the patient’s lumbar region to help relax his muscles and minimize muscle spasms. He then reports this service with CPT code 97010.
Using a Cold Pack to Reduce Knee Joint Swelling
People with chronic osteoarthritis (OA) also often require the application of thermal modalities to the affected joint to reduce inflammation or pain. Did you know that this degenerative condition affects 88% of people who are 45 or older?
Therefore, let’s assume a 47-year-old man with chronic OA arrives at an outpatient therapy center with mild swelling on his left knee. After strengthening exercises, the therapist applies a cold pack to the affected area to reduce joint inflammation. His billing team then documents this use of a cold pack with CPT code 97010.
Applicable Modifiers for CPT Code 97010
Confused about using modifiers with CPT code 97010? You can apply the following modifiers to this code:
Modifier GP
Some payers require the use of modifier GP with CPT code 97010. This two-character code indicates that the service, the application of a thermal modality in this scenario, was provided under an outpatient physical therapy plan of care.
Modifier 59
Was the application of a thermal modality distinctly separate from other services you performed on the same patient on the same day? In that case, append modifier 59 or one of its more specific alternatives (XE, XS, or XU) to CPT code 97010.
CPT Code 97010 – Billing & Reimbursement Guidelines
Are you following the right guidelines for using CPT code 97010? You must familiarize yourself with the standard billing rules for this code to avoid denials or penalties.
Verify Coverage
Before applying or billing for a thermal modality, always confirm its coverage. This includes verifying whether a patient’s insurance plan covers CPT code 97010 as a separate service. For example, Medicare considers the application of a modality as a bundled service. Hence, it does not offer separate reimbursement for it.
Use CPT Code 97010 Correctly
Remember that the 97010 CPT code only covers the application of a hot or cold pack. Hence, avoid using it for other therapeutic modalities, such as electrical or mechanical. Moreover, since this is an untimed code, you must report it as one unit per session, regardless of the duration or the number of areas you treated.
Comply with the Documentation Requirements
Another important piece of advice is to accurately document CPT code 97010. This involves recording relevant details, like:
- Clinical reason for the application of a hot or cold pack (inflammation, joint stiffness, pain)
- Appropriate ICD-10 codes
- Body parts treated
- Type of thermal modality (hot or cold pack)
- Patient response to treatment
- Duration
The last detail is important even though the 97010 CPT code is untimed. This is because insurance payers often require information about how long you applied a hot or cold pack to the affected area.
Append Modifier GP (If Required)
Many insurers also require the use of modifier GP with CPT code 97010 if the service is part of a physical therapy plan.
Summary
Did this blog clarify your confusion about CPT code 97010? Most payers deny separate reimbursement for the application of a hot or cold pack because they consider it a bundled service. Therefore, the 97010 CPT code is mostly non-billable as a standalone service. From description to best practices, we have explained this code quite thoroughly, so you can use it with confidence.
But if you want to address your denial issues, consider a billing specialist to handle your coding. Many experts, including MediBillMD, guarantee clean claim submissions and accurate coding. Hence, choose one of the reliable physical therapy billing services to improve your revenue.
