CPT Code 97012: Application of a Modality to One or More Areas; Traction, Mechanical - Chirotouch
July 24, 2023 by ChiroTouch Team Article Coding

In this quick reference guide to CPT code 99205, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors. 

About CPT Code 97012: Application of a Modality to 1 or More Areas; Traction, Mechanical

CPT code 97012 refers to the application of a modality, specifically mechanical traction, to one or more areas of the body. This modality is commonly used in chiropractic practice to address various musculoskeletal conditions, particularly those involving spinal or extremity pain and dysfunction.

Here’s what chiropractors need to know about using CPT code 97012.

Category or Type of Service

CPT code 97012 falls under the category of Physical Medicine and Rehabilitation services. It represents a specific therapeutic modality aimed at addressing musculoskeletal conditions through mechanical traction.

Billing Interval

This code is typically billed per session. It’s a time-based code; many payers require a minimum of 8 minutes of treatment for a billable unit. The duration and frequency of mechanical traction sessions may vary depending on the patient’s condition and treatment plan determined by the chiropractor.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 97012 for patient encounters involving mechanical traction to one or more areas of the body. Mechanical traction is often used for conditions such as:

  • Spinal disc herniation or degeneration
  • Spinal stenosis
  • Facet joint syndrome
  • Radiculopathy
  • Musculoskeletal pain and stiffness

When Should Chiropractors Not Use This Code?

Chiropractors should avoid using CPT code 97012 for:

  • Manual traction or electrical stimulation treatments
  • Encounters where mechanical traction is ruled out, such as acute fractures, malignancies, or certain vascular disorders
  • Sessions where mechanical traction is not the primary therapeutic intervention or where its effectiveness is questionable

Which Modifiers Can Be Used With CPT Code 97012?

The most common modifiers used with this code are:

  • Modifier 59. Indicates that a procedure or service was distinct or independent from other services performed in the same session.
  • Modifier AT. Used to note that a service or procedure was performed for an acute or chronic subluxation. This modifier is often used in chiropractic settings where mechanical traction is used to address subluxation-related conditions. However, its use is highly dependent on the specific payer and state guidelines. Some payers may not recognize the AT modifier or may have specific rules about its use.

Billing Guidelines and Documentation Requirements

Sticking to billing guidelines streamlines the claims process. Be sure to:

  • Document the specific areas of the body to which mechanical traction is applied.
  • Record the duration and intensity of mechanical traction sessions.
  • Justify the medical necessity of mechanical traction based on the patient’s diagnosis, clinical presentation, and treatment goals.
  • Ensure clear, legible, and comprehensive documentation to support the billed services.

Review your documentation before billing to make sure it justifies using 97012. Documentation should also highlight both the areas you’ve targeted and the ones you’ve treated.

Common Mistakes Made Specific to CPT Code 97012

Avoid these common mistakes when using CPT code 97012:

  • Inappropriate or excessive use of mechanical traction without adequate justification or that falls outside the established treatment protocols
  • Failure to document the specific parameters of mechanical traction sessions
  • Billing for mechanical traction sessions without confirming medical necessity or efficacy for the patient’s condition
  • Insufficient or inconsistent documentation regarding the application and outcomes of mechanical traction

Potential Audit Triggers for CPT Code 97012

Be aware of potential audit triggers, including:

  • Billing for mechanical traction without supporting documentation of medical necessity
  • Inconsistent use of modifiers or improper use of modifier 59
  • Lack of documentation regarding the duration, intensity, and response to mechanical traction therapy
  • Unusual billing patterns or discrepancies in mechanical traction utilization, such as using 97012 far more often than other more appropriate codes

Improving Billing and Coding Processes

To enhance accuracy and efficiency in billing and coding:

  • Ensure thorough documentation of mechanical traction sessions, including indications, parameters, and outcomes.
  • Conduct regular audits of billing and coding practices to identify and address potential issues.
  • Stay updated on coding regulations and changes related to physical medicine and rehabilitation services.

Understanding and applying CPT code 97012 correctly can facilitate optimal reimbursement and compliance with coding guidelines for chiropractic practices incorporating mechanical traction therapy into patient care.

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