24 hour Iontophoresis patch (Full Version)

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Sam B -> 24 hour Iontophoresis patch (August 25, 2003 10:15:00 PM)

Hi,

How do you bill for those 24 hour ionto patches? We had been billing for the Iontophoresis charge (97033), but I checked it, an Ionto is listed as a constant attendance modality.

Do I use an unspecific code, or bill for e-stim unattended? Any pearls of wisdom?
(those patches aren't cheap!)

Thanks,

Sam

[This message has been edited by Sam B (edited September 10, 2003).]



mcap56 -> Re: 24 hour Iontophoresis patch (August 26, 2003 12:09:00 AM)

Sam:

At my last job, I don't think we billed for them. I really don't see how you can. If you spend at least 8 minutes explaining the use, purposes and precautions to them then you may be able to count it as something, perhaps ther act, directed 97530. However, I am not sure. You may just have to write this one off.

The thing to do would be to stock some of them and charge appropriate overhead.

Best,
Mcap



hgross -> Re: 24 hour Iontophoresis patch (August 26, 2003 5:56:00 PM)

Sammons Preston recently sent me info on the IontoPatch and included a letter from Birch Point Medical, which states the AMA wrote that from a coding perspective, the use of the IontoPatch should be reported using code 97033 for the attended portion of the treatment (in the clinic). Sammons Preston went on to say that this letter was reviewed and found acceptable by their reimbursement consultant and also by selected reimburesement opinion leaders within the APTA.
Since I have never personally used this product, I wouldn't know about how much direct time is spent on patient contact to deliver this service. Is it 8 minutes? You are assessing the need for the ionto, most appropriate site, prepping, filling and placing the patch, so it would seem appropriate.



Sam B -> Re: 24 hour Iontophoresis patch (August 26, 2003 7:44:00 PM)

Hi,
Thanks for the replies. Personally, I tend to agree with mcap that using the 97033 code for the patch is a stretch. It takes me 3-4 mins tops to apply the patch. I could fudge 3-4 mins to get myself up to 8 mins, but I don't think I'm comfortable with that. I am glad the APTA may be OK with the 97033 code, but I would have to defend my actions to the state board or medicare if audited. I am not sure how far their opinions would help me in my defense, when the CPT code book seems pretty clear on the matter. I can see how the set-up of the patch could be "stretched" to a constant attendance item, but I don't like things too grey. I know the AMA writes the CPT code book, but it still seems "iffy"
We will be looking at other ways to make up the cost of that item in other areas, if appropriate.
I gotta feel good about how I do things I suppose. Maybe that'll keep me poor!

Thanks for the much needed input!
Sam B



TLB -> Re: 24 hour Iontophoresis patch (August 27, 2003 2:02:00 PM)

First thing I would ask is does the insurance even cover Ionto. Most don't with the exception of BC/BS and W/C @ least in Arizona. You always have the cash option if the insurance doesn't cover or bill the attended code. Any thoughts on this?



hgross -> Re: 24 hour Iontophoresis patch (August 27, 2003 5:09:00 PM)

All good points on the coverage issues, but what about just describing the service you do? That is my understanding of what a CPT code is. You can "report" (in your note) that you did Ionto for 3 minutes, then don't bill it. I do that frequently when I do 3 procedures in the clinic but only spent 30 minutes with the patient. For instance, US 8 minutes, Manual therapy 15 minutes and ther ex 5 minutes = 28 minutes, bill 2 (US and manual). It seems like there are more and more things that we do that we can't bill for anymore. Medicare won't pay for "pre-op" ther. exercise or for Ionto in our LMRP.



Shill -> Re: 24 hour Iontophoresis patch (August 27, 2003 5:22:00 PM)

On a side note, I spoke with folks from Empi regarding this device, and they brought up some good points,( and the reason their company chose to not get into the patch business) including how do we know that the person is getting anything more than a patch with medication placed on their skin? That is to say, what if the pre-packaged battery is dead? How would we know? There are no objective measures of treatment delivered with the patches. (other that what the packages says is supposed to be delivered). We also send the patients home, so that we cant check the skin after the treatment (albeit the likelihood of a burn is seemingly non-existant) and this could lead to claims of negligence, if an adverse reaction is experienced. Just some things to think about.



fiu_ptstudent -> Re: 24 hour Iontophoresis patch (August 27, 2003 6:49:00 PM)

The biggest issue we faced in the clinic I worked in was the reimbursement was too low. We actually lost some money by using the IontoPatch. The PT loved it and got such good results she decided to use it anyway.



PTupdate.com -> Re: 24 hour Iontophoresis patch (August 28, 2003 9:26:00 AM)

As shill indicates, how can we even monitor something that we put on and send them home? I don't know how many times I tell people, when taping the shoulder, to leave on only for a few days, and then have them return a week later still taped. Risk of skin irritation is too great, not to mention some weird tan lines. How many patients will leave the patch on, thinking "more is much much better?"

Besides, I usually ice patients after a treatment, so adding the ionto during that time is not really a problem.

What a shame we have been reduced to timing everything for 8 minutes, regardless as to how effective it is? How many people are just dragging out the process to justify their billing? Between this and the return of the cap, it is so great to see we have people working in our corner!

John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



hmgross -> Re: 24 hour Iontophoresis patch (August 29, 2003 12:20:00 PM)

Amen to the stupid 8 minute rule. How many times have I used a very effective 5 minute manual therapy technique which required a great deal more brain power and skill than an ultrasound. Quite frustrating.



hmgross -> Re: 24 hour Iontophoresis patch (August 30, 2003 12:46:00 PM)

Just looking at this again. Is there research to support the effectiveness of the 24 hour patch vs. the Ionto rx performed in the clinic? Does anyone out there have experience with this treatment? You always have to weigh the risk and benefit to the patient. We often send patients home with TENS units after instructing them in proper use, precautions, etc. There is always the potential for injury to the skin however, but you need to document that you trained the patient on the proper use of the device.



chipomalley -> Re: 24 hour Iontophoresis patch (September 1, 2003 11:26:00 AM)

Hopefully someday we can be paid on a visit charge or an hourly rate. I have thought that charges could be substantially lower if we did not have to cover office and administrative expenses. We still could be paid well and make a profit. Insurance costs would decrease so the skyrocketing copays could be pulled back. I think its part of where we need to go towards the next level, DPT and independent practice. The system is going to collapse on itself otherwise. There are those who want the individual code maze to continue however. These may be profiteers on the provider side as well as the payors who want to pick apart claims for denial. Meanwhile, who loses? The patient. Sorry, the coding thing got me going again.

Chip



hmgross -> Re: 24 hour Iontophoresis patch (September 3, 2003 1:29:00 AM)

I guess there is something to be said for procrastination! I had the Sammons Preston packet on my desk all summer and never got around to calling them about the patch. I think I will stick with what we have been using. Speaking of coding for procedures that don't get covered, we really seem to be "eating it" when it comes to wound care. We are rural and these patients have no where else to go, so bottom line is, treat the patient because they need it (I am also a therapy manager so I am constantly trying to educate the administrator and board on why we aren't the big money-makers anymore).



PTupdate.com -> Re: 24 hour Iontophoresis patch (September 3, 2003 10:13:00 AM)

I thought Medicare decided in April that it would pay for electical stimulation for wounds, provided the patient met certain criteria?

Duffy [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



hgross -> Re: 24 hour Iontophoresis patch (September 3, 2003 12:48:00 PM)

Yes, e-stim is covered for chronic stage III and IV ulcers after a period of 30 days of no significant improvement. We see some wound care patients that don't fit that criteria.



mikereinold -> Re: 24 hour Iontophoresis patch (September 12, 2003 11:52:00 PM)

I have used "the patch" with great subjective success (isn't that why we do anything?). Empi puts its down because they are developing their own. For more info, we have a paper on the Iontopatch at [URL=http://www.sportsmedrx.com,]www.sportsmedrx.com,[/URL] click on articles and you will find it.



------------------
Michael M. Reinold, PT, ATC
www.sportsmedrx.com



jrazo -> Re: 24 hour Iontophoresis patch (February 26, 2006 10:41:00 PM)

OK, I dug this tread out of the dungeon, but there has been a couple of years for this issue to simmer. We currently use the patch in the Navy Hospital that I work in and I am curious if the billing procedure has been figured out or is it still a controversy?

Joe



KIDPT23 -> Re: 24 hour Iontophoresis patch (February 27, 2006 6:12:00 AM)

Medicare allows the patch to be billed as 97033. If you are not billing it out then you are taking yet another billable charge away from an already thinning list.



dosrinc -> Re: 24 hour Iontophoresis patch (February 27, 2006 7:14:00 AM)

i have used the patch the last couple of years with moderate success, dont use the machine anymore after having a couple of people get upset with the small poc mark burns that happen on occasion, bill ionto as we were told to do by our intermediary (which still barely covers the cost of the patch itself, much less the time)

On an interesting side note, took a course given by a pharmacologist one time who took note of the fact that we PT's are a weird bunch, using electricity to drive what is already a transdermal drug (dexamethasone), an interesting point, maybe we should just put it on under a band-aide and get the same results?
Rick



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