Did you know that a research study published by the National Library of Medicine found that cold therapy reduces pain in delayed onset muscle soreness (DOMS) patients within the first 24 hours after exercise? Additionally, hot therapy can minimize pain in patients both before and after 24 hours.
While the cold or hot pack application may seem insignificant, it helps healthcare providers achieve treatment goals during therapy sessions. This guide is dedicated to one such procedural code, i.e., CPT code 97010.
We will discuss everything you need to know about it, from real-world clinical scenarios to applicable modifiers and billing guidelines. So, continue reading!
What is CPT Code 97010?
CPT code 97010 is an untimed code. It covers the application of a cold or hot pack to a specific body site to treat a disease or injury. A healthcare provider, such as a physical therapist, performs this service.
Scenarios Where CPT Code 97010 is Applicable
Let’s review a few real-world clinical scenarios where CPT 97010 applies:
Acute Sports Injury
Picture a 23-year-old male athlete who has come to the clinic. The reason? He sustained an acute Grade II lateral ankle sprain 24 hours ago. Besides, he has a significant edema (swelling) accompanied by localized pain.
Thus, the provider applies a cold pack wrapped in a protective towel to the lateral malleolus for 15 minutes (CPT code 97010). The aim here is to induce vasoconstriction and reduce acute inflammatory markers.
Pre-Treatment for Chronic Muscle Stiffness
Consider a 54-year-old female patient who comes for a scheduled therapy session. She has a history of chronic low back pain and lumbar muscle guarding. On arrival, she also complains about experiencing high levels of stiffness that limit her ability to perform stretching.
Thus, the physical therapist applies a moist heat pack with 6 to 8 layers of toweling to the lumbar paraspinal muscles for 10 to 15 minutes. This increases local blood flow and tissue elasticity. Additionally, it improves the effectiveness of subsequent manual therapy and therapeutic exercise.
Here, CPT code 97010 should be reported with 97140 and 97110.
Post-Surgical Rehabilitation
Imagine a 66-year-old male patient who underwent a total knee arthroplasty 2 weeks ago.
During a recent post-surgery rehabilitation session, the surgical site shows increased warmth and minor throbbing pain. For context, the session involved a vigorous 40-minute session of gait training and strengthening.
Therefore, the physical therapist applies a cold pack (CPT code 97010) to the anterior knee for 15 minutes at the conclusion of the session.
Applicable Modifiers for CPT Code 97010
Discussed below are the applicable modifiers for CPT 97010:
Modifier GP
Append modifier GP to CPT code 97010 to highlight to the insurance payer that the hot or cold pack application was performed under an outpatient physical therapy plan of care.
Modifier GO
What happens when you perform the cold or hot pack application under an outpatient occupational therapy plan of care? You append the modifier GO to CPT code 97010 to inform the payer.
CPT Code 97010 – Billing & Reimbursement Guidelines
The following are some of the essential billing guidelines for CPT 97010:
Understand the Bundling Rules
Note that Medicare designates CPT code 97010 as a status B code. Simply put, its reimbursement is included in other therapy codes. As a result, Medicare and other commercial payers that follow its lead will never pay for it separately.
However, some private payers may still pay a small fee for the application of hold or cold packs. Thus, you should always check with the specific payer before submitting the claim.
Never Report More Than 1 Unit
You can only bill CPT code 97010 once per claim, regardless of how long the hot/cold pack was applied or how many body parts you treated with it.
For example, applying an ice pack to both knees and a hot pack to the back in one visit equals only one unit of 97010. Similarly, whether the pack application lasted for 5 minutes or 20 minutes, you will bill a single unit.
Fulfill Documentation Requirements
Regardless of whether the payer reimburses CPT code 97010 or not, you should ensure comprehensive documentation. Thus, include the following:
- Specify the modality type. For example, cold compression, moist heat pack, ice pack, etc.
- Mention the location where you applied the pack. For example, applied to the right lumbar paraspinals.
- Describe the patient’s position. For example, prone with two pillows for support.
- Explain what safety measures you considered while performing the procedure. For example, 6 layers of towelling, etc.
- State the goal of the hot or cold pack application.
- Mention the duration.
Summary
With that said, it is time to conclude this guide. However, before bidding farewell, here’s a quick overview of what we discussed.
CPT code 97010 covers the application of a hot or cold pack to a specific body part to treat an injury or disease. Medicare does not reimburse it separately, but some private payers may pay a fee for this service. Besides, you can only bill one unit of it regardless of the time spent or the number of body parts treated.
Hopefully, these guidelines will help you ensure error-free reporting of CPT 97010. However, if you still struggle, consider outsourcing physical therapy billing services to professionals, like NeuraBill.
FAQs
Does Medicare pay for CPT code 97010?
Medicare bundles the reimbursement for CPT 97010 with other therapy codes. This means it is not a separately billable code (with or without a modifier).
What is the time frame for CPT code 97010?
It is an untimed procedural code. However, while reporting it, you should document the duration as a best practice and to comply with payers’ documentation requirements.
