Vasopneumatic Modality - CPT 97016

Multiple outpatient therapy reviews have had insufficient documentation to support appropriate use and billing for the use of a vasopnuematic device. A vasopneumatic device is utilized to apply pressure to an extremity to reduce swelling.

Vasopnuematic devices are billed with CPT 97016 with short descriptor "application of blood vessel compression or decompression device to one or more areas" is an untimed code. It is defined as a service-based, "always therapy" code and applicable therapy modifiers must be provided. Since there is no time requirement for this code, it is always billed as 1 unit no matter how long it takes to deliver the service.

To meet Medicare's coverage requirements, vasopneumatic services must be provided by a qualified clinician i.e., physician, non-physician practitioner, licensed therapist and/or therapy assistant. Also, the medical record must support that the services provided meet Medicare's medical necessity standard as supported in the initial evaluation, certified plan of care, progress reports and treatment encounter notes for the episode of care. Documentation must demonstrate that the edema is clinically significant, interferes with the patient's functional abilities and fully meets the CPT® code descriptor requirements.

For additional information reference the CPT Coding Manual and the CMS Internet Only Manual (IOM), Publication 100-02, Chapter 15, Section 220.2.

            Last Updated Fri, 14 Dec 2018 16:18:19 +0000