It pays to pay close attention.

As consultants for doctors who provide decompression services and as postgraduate instructors on decompression coding and marketing compliance, nothing happens in the spinal decompression arena without us hearing about it within hours.

With regard to proper coding for decompression services, it is a subject you should pay close attention to because improper coding has already sent several doctors of chiropractic to federal prison!

Perhaps the most important dynamic in this area is the ever-shifting position of insurance companies as they attempt to develop some kind of consistent policy regarding the coding of spinal decompression services.

While some insurance carriers are all over the map with regard to their policies, we remain convinced that the two appropriate codes for spinal decompression therapy are 97012 (mechanical traction), which will result in very limited reimbursement under insurance policies; and S9090 (Vertebral Axial Decompression), which will usually result in no reimbursement—but will allow the doctor to collect from the patient.

The validity of those two codes is not just our opinion; it is the official position of the American Chiropractic Association. To review the ACA's official coding policy on vertebral axial decompression, go to www.MarketDecompression.com/aca.doc.

Most carriers are now echoing the advice we have been giving our clients over the last few years. The position of Blue Cross Blue Shield of Louisiana reads as follows:

Spinal Decompression Therapy Devices: Services performed utilizing any type of spinal decompression therapy device must be billed with HCPCS code S9090. Blue Cross considers these services to be investigational. They are not payable and providers may bill the patient for these services.

Blue Cross considers Vax-D, Triton DTS and 3-D Autotrack devices to be "decompression therapy devices." Audits conducted by Blue Cross that reveal the utilization and payment of particular machine charges may result in recoupments. [Emphasis added]

Blue Cross Blue Shield of Kansas City concurs, and below are the pertinent points from its May 18, 2007, communication to its contracted providers:

This is an important notice from Blue Cross and Blue Shield of Kansas City (BCBSKC) that vertebral axial decompression treatments are considered investigational and therefore not covered. The use of improper codes for these services could result in severe sanctions, including contract termination.

Again, BCBSKC does not provide coverage for vertebral axial decompression. Regardless of available coverage, all services reported on a claim must be accurately identified by appropriate CPT, HCPCS and/or ICD-9 codes and must be supported by the medical record documentation. BCBSKC relies on providers in the medical community to accurately code claims reflecting services provided so member benefits can be correctly applied. We expect vertebral axial decompression services to be billed appropriately as S9090. [Emphasis added]

But here's the "rub." While we agree with BCBSKC that S9090 is the most appropriate code, we strongly disagree with the following statement in its letter:

For vertebral axial decompression services, treatment sessions include all the therapeutic modalities performed in preparation for the service, as well as the actual decompression therapy and the post-decompression modalities performed to recover from the service.

That means any hot/cold packs (CPT 97010), infrared treatments (CPT 97026), therapeutic exercise procedures (CPT 97110), and/or therapeutic activities procedures (CPT 97530) would be denied if performed on the same date of service.

In truth, this assertion is a giant leap for it to attempt to make. Upon review of Current Procedural Terminology, nothing in the descriptors for any of these aforementioned procedures or services suggests that they are provided to "recover from" a decompression session.

Rather, those treatments are quite clearly stand-alone procedures performed for an entire host of possible conditions and illnesses. Only if the provider—somewhere in the documentation—indicated that the services were provided "to relieve soreness caused by application of the decompression service" might a carrier possibly be able to win this argument. Without question, most doctors provide these services to address the inflammation/symptoms associated with the patient's degeneration/herniation. Hopefully, BCBSKC will soon be challenged on its flawed policy and change it.

And finally, we are often asked if our spinal decompression fee covers other services that are performed. The answer is no!

While most patients pay for the spinal decompression services out of pocket, all other services are submitted to the patient's insurance company for reimbursement. At left are some of the most common CPT codes and services that can be billed in conjunction with spinal decompression therapy if indicated.

James D. Edwards, DC, served 8 years on the Kansas State Board of Healing Arts and is a past ACA chairman of the board, past chairman of the National Chiropractic Legal Action Fund, and past chairman of the ACA-PAC.

Cynthia S. Vaughn, DC, served 3 years as president of the Texas Board of Chiropractic Examiners and is a past member of the VA Chiropractic Advisory Committees. She currently serves as chairman of the ACA Clinical Documentation Committee and East Texas ACA Delegate. Edwards and Vaughn can be contacted by e-mail at .