Joined: September 25, 2007
Hi. So suddenly all of my claims containing 97035 (ultrasound) are being denied since 11/26/2013. They said ICD-9 is not medically necessary. I have mostly osteoarthritis/ rheumatoid arthritis pts and am in Los Angeles. Is this happening to anyone else? My biller is looking into it too but asking me to change ICD-9 codes. I am looking for some insight.
From: boynton beach, fl
a LONG time ago, there was a First coast edit here in FLA that did this after something like 14 uses of that code on a patient... it no longer does it, but it may be a trigger...i would check it out...
Joined: September 6, 2006
From our LCD, california may be a little different, but this should give you some insight
Specific indications for the use of ultrasound application include but are not limited to: limited joint motion that requires an increase in extensibility; symptomatic soft tissue calcification; neuromas. Ultrasound application is not considered reasonable and necessary for the treatment of: asthma, bronchitis, or any other pulmonary condition; conditions for which the ultrasound can be applied by the patient without the need for a therapist or other professional to administer, and/or for extended period of time (e.g., devices such as PainShield MD); wounds. (see list “ICD-9 Codes that DO NOT Support Medical Necessity” Phonophoresis (the use of ultrasound to enhance the delivery of topically applied drugs) will be reimbursed as ultrasound, billable using CPT 97035. Separate payment will not be made for the contact medium or drugs.
Ultrasound with electrical stimulation provided concurrently (e.g., Medcosound, Rich-Mar devices), should be billed as ultrasound (97035). Do not bill for both ultrasound and electrical stimulation for the same time period.
If no objective and/or subjective improvement is noted after 6 treatments, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of ultrasound. Documentation must clearly support the need for ultrasound more than 12 visits.