Careless Use of Coding
Legal Department
Written by Larry Economos, Esq.   
Tuesday, 26 July 2005 18:51 Read : 839 times

In 1999, Dr. Joseph purchased a hydro therapy modality table, commonly known as a hydrobed, a water based massaging device which is more or less a bed upon which a patient lies for treatment. There being no specific current procedural terminology code for this modality, the manufacturer recommends the use of one of three plausible codes: 97022 (whirlpool); 97214 (massage); or 97139 (unspecified procedure). Dr. Joseph, realizing that insurance companies reimburse 97022 (whirlpool) at a slightly higher rate than the others, uses the whirlpool code for billing purposes throughout 2003, never bothering to contact his chiropractic board or the insurance companies to get an opinion as to the proper code for use.

In 2001-02, the American Chiropractic Association, acknowledging confusion in the industry as to the proper coding for hydrobed therapy, issues a position statement suggesting that the proper code to use for billing purposes is 97139 (unspecified procedure).  Unfortunately, Dr. Joseph never is made aware of the ACA’s position statement until after being criminally indicted for, among other things, coding hydrobed therapy as 97022 (whirlpool) from 1999 to 2003. 

Guilty or not guilty?

Dr. Joseph is found guilty of mail fraud in coding hydrobed therapy as 97022 (whirlpool) from 2001 through 2003.  His defense of plausible interpretation of an ambiguous billing code is refuted by his choice of a code for greater financial gain in the face of industry recommendation of a preferable code that reimbursed at a lower rate.

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address, www.leconomoslaw.com, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.


 
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