CPT Code 97028: Application of a Modality to One or More Areas; Ultraviolet - Chirotouch

In this quick-reference guide to CPT code 97028, 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 97028: Application of a Modality to One or More Areas; Ultraviolet

CPT code 97028 pertains to ultraviolet (UV) therapy applied to one or more areas of the body. This supervised physical medicine modality is used primarily by dermatologists to treat eczema and psoriasis, but it is used occasionally in chiropractic care for various therapeutic purposes.

The use of UV therapy by chiropractors would be contingent upon their training, the legal scope of practice in their region, and the evidence supporting UV therapy for the conditions being treated.

It is important to consult with a qualified healthcare professional regarding the suitability of ultraviolet therapy for each patient and to follow all safety guidelines when using this modality.

Category or Type of Service

CPT code 97028 falls under the category of Physical Medicine and Rehabilitation. It is commonly used by chiropractors as part of a comprehensive treatment plan to address musculoskeletal conditions and promote patient well-being.

Billing Interval

Typically, code 97028 is billed per session. Document the duration and specifics of each session accurately to ensure proper billing and reimbursement.

When Should Chiropractors Use This Code?

Chiropractors can consider using CPT code 97028 in the following scenarios:

  • Pain management. UV therapy can be employed to alleviate pain associated with various musculoskeletal conditions, such as arthritis, muscle strains, and bursitis.
  • Inflammation reduction. UV therapy may be used to reduce inflammation and promote healing in targeted tissues.
  • Wound healing. In some cases, UV therapy can be used to stimulate healing in chronic wounds.

When Should Chiropractors Not Use This Code?

Chiropractors should avoid using CPT code 97028 in certain situations, such as:

  • Lack of medical necessity. If UV therapy is not deemed medically necessary or does not contribute to the patient’s treatment goals, it should not be billed.
  • Unsubstantiated claims. Avoid billing for UV therapy sessions that lack documented evidence of their therapeutic benefit or relevance to the patient’s condition.
  • Contraindications. UV therapy is not suitable for all patients. Be aware of contraindications, such as photosensitivity or certain medications, before using this modality.
  • Home UV therapy.

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

Adhering to proper billing guidelines and documentation requirements is essential for accurate reimbursement and compliance. For CPT code 97028, be sure to address the following:

  • Treatment duration. Document the duration of each UV therapy session to support billing accuracy.
  • Medical necessity. Clearly articulate the medical necessity of the therapy in the patient’s treatment plan, including relevant diagnoses and treatment objectives.
  • Detailed treatment notes. Maintain detailed treatment notes that outline the rationale for employing UV therapy, the specific areas targeted, treatment parameters (dosage, wavelength), and the patient’s response to treatment.
  • Scope of practice considerations. Chiropractic scope of practice varies by jurisdiction and is defined by regulatory boards. In some areas, the use of UV therapy may fall within the scope of chiropractic practice, especially if it’s used for musculoskeletal conditions.
  • Evidence-based practice. The integration of any therapeutic modality, including UV therapy, into patient care should be grounded in evidence-based practice. This means that its use should be supported by credible research demonstrating effectiveness for the condition being treated.

Common Mistakes Made Specific to CPT Code 97028

Avoiding common pitfalls associated with CPT code 97028 can help ensure proper billing and compliance. The most common mistakes include:

  • Overutilization. Employing UV therapy excessively or without adequate justification can lead to inappropriate billing and potential audit scrutiny.
  • Insufficient documentation. Failing to document the medical necessity, treatment parameters, and patient response can result in claim denials or audit findings.
  • Incorrect billing. Ensure accurate billing by verifying the appropriateness of using CPT code 97028 for each patient encounter and confirming adherence to payer guidelines.

Potential Audit Triggers Specific to This CPT Code

Certain factors may trigger audits or scrutiny related to the use of CPT code 97028:

  • Unusual billing patterns. An unusually high frequency of UV therapy sessions or inconsistencies in billing practices may attract audit attention.
  • Documentation discrepancies. Discrepancies between documented treatment notes and billed services can raise red flags during audits.
  • Lack of medical necessity. Inadequate documentation supporting the medical necessity of UV therapy sessions may prompt further review by auditors.

What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?

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

  • Regular audits. Conducting routine audits of billing and coding practices to identify and address discrepancies or errors.
  • Continuing education. Staying informed about updates and changes to coding regulations and payer policies through ongoing education and training.
  • Utilizing technology. Leveraging electronic health record (EHR) systems and practice management software designed for chiropractors to streamline coding workflows and ensure compliance with documentation requirements.

By implementing these strategies, chiropractors can optimize their billing and coding practices for UV therapy services, minimize errors, and maintain compliance with regulatory standards.

Streamline Coding and Billing With ChiroTouch

Managing a chiropractic practice involves dedicating time to coding and billing, yet choosing the optimal system can transform this aspect of your business from a burden to a powerful driver of success.

With ChiroTouch, you gain direct access to enhanced billing features, including automated claim submission, real-time eligibility checks, and streamlined payment processing. Schedule a demo today to experience its benefits firsthand.

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