CPT Code 97022: Whirlpool - Billing, Modifiers, Mistakes

In this quick-reference guide to CPT code 97022 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. 

NOTE: CPT codes and guidelines can be revised over time. To avoid billing issues, be sure to stay current with annual coding updates and changes to payer guidelines.

About CPT Code 97022: Application of a Modality to 1 or More Areas; Whirlpool

CPT code 97022 refers to an encounter where patients use a whirlpool. This code is often used by chiropractors to provide therapeutic treatment for patients experiencing musculoskeletal discomfort or injuries, most commonly swelling, muscle spasm, or pain.

Category or Type of Service

CPT code 97022 falls under the category of Physical Medicine and Rehabilitation services. It’s used to bill for using a whirlpool to alleviate pain, spasm, or inflammation in established patients.

Billing Interval

This code is typically billed per encounter. It is essential to note that the duration and frequency of time in the whirlpool may vary based on the patient’s condition and treatment plan.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 97022 when using the whirlpool as part of a patient’s treatment plan.

This may include scenarios such as:

  • Providing relief for acute musculoskeletal injuries.
  • Reducing inflammation in chronic conditions, such as arthritis and tendonitis.
  • Aiding postsurgical recovery.
  • Managing pain associated with various musculoskeletal conditions.
  • This code typically does not cover other types of hydrotherapy, such as hydrotherapy, aquamassage, hydromassage, or hydrotherapy massage, or dry heat therapies such as fluidotherapy or fluidized therapy.

Note that not all jurisdictions may consider whirlpool therapy within the standard scope of chiropractic care. Verify local regulations and payer policies before using this code.

When Should Chiropractors Not Use This Code?

Chiropractors should avoid using CPT code 97022 in certain situations, including:

  • When the patient uses a whirlpool as unsupervised patient prep or as a post-treatment comfort measure.
  • When providing other modalities or treatments not covered by this specific code.
  • When whirlpool use is provided outside of a treatment plan or suggested as part of home care.

Which Modifiers Can Be Used With CPT Code 97022?

Modifiers may be used to provide additional context or information regarding the service provided. Common modifiers used with CPT code 97022 include:

  • Modifier 25. This indicates other E/M services were provided during the same visit.
  • Modifier 59. This is used to communicate that the service was distinct or independent from other services performed on the same day. This modifier must be used judiciously and only when its specific criteria are met. Overuse of this modifier is a notorious audit flag.
  • Modifier 76. This is used to indicate a repeat procedure or service by the same physician or qualified healthcare professional.

What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

Chiropractors must adhere to specific billing guidelines and documentation requirements when using CPT code 97022, including:

  • Ensuring that using a whirlpool is medically necessary and supported by the patient’s diagnosis and treatment plan.
  • Documenting the location, duration, and frequency of whirlpool use.
  • Providing clear and detailed documentation to support the medical necessity of the service rendered.

Common Mistakes Made Specific to CPT Code 97022

Some common mistakes made when using CPT code 97022 include:

  • Failing to document the medical necessity of using the whirlpool.
  • Using the code for services not covered under this specific CPT code.
  • Inaccurate reporting of the location, duration, or frequency of the modality application.
  • Billing for this procedure in a jurisdiction or for a payer that doesn’t recognize this modality as within the standard scope of chiropractic care.

Potential Audit Triggers Specific to CPT Code 97022

Auditors may scrutinize claims involving CPT code 97022 for various reasons, including:

  • Inadequate documentation supporting the medical necessity of the service rendered. A supporting ICD-10 diagnosis code is always required alongside the CPT code for reimbursement.
  • Billing for services not provided or not meeting the requirements outlined by the code.
  • Inconsistencies between reported services and documentation.

Clear and accurate documentation is your best tool to prevent audits with this code.

Improving Billing and Coding Processes

Chiropractors can improve the accuracy and efficiency of their billing and coding processes by:

  • Conduct regular internal audits. Chiropractors should regularly audit their billing and coding practices to ensure compliance with coding guidelines and payer policies. Internal audits help identify any discrepancies or areas for improvement in documentation and billing practices.
  • Staying updated on coding regulations. It’s crucial for chiropractors to stay informed about changes to billing and coding regulations. This includes staying abreast of any updates to coding guidelines, reimbursement policies, and documentation requirements issued by relevant regulatory bodies and payers.
  • Providing appropriate education and training. Chiropractors and their staff should receive appropriate education and training on billing and coding guidelines. This may include workshops, seminars, or online resources focused on coding compliance, documentation best practices, and understanding payer policies.
  • Using modern technology solutions. Chiropractors can leverage cloud-based electronic health record (EHR) and practice management software tailored to the needs of chiropractors to streamline billing and coding processes.

By understanding the proper use of CPT code 97022 and sticking to billing and coding guidelines, chiropractors can ensure accurate reimbursement for the services they provide while delivering quality care to their patients.

Free Up More Time For Patients With ChiroTouch

Bringing together twenty years of experience working with over 36,000 customers, ChiroTouch was designed by chiropractors to meet the needs of providers and billers.

Designed with an intuitive understanding of the chiropractic profession’s needs, ChiroTouch streamlines the entire billing cycle. From the initial patient visit to the final payment, every step is integrated into a single, user-friendly dashboard. This consolidation of features eliminates the clutter of disjointed applications, enabling a smoother workflow that prioritizes efficiency and accuracy.

And because it’s in the cloud, your data is protected with automatic backups and updates.

If you’re ready to modernize your practice and spend more time doing what you love, book a demo today!

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