Documentation and Payment for Vasopneumatic Devices

vasopneumatic devices
May 19, 2015
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Vasopneumatic devices, such as the Game Ready, that provide a combination of cryo and compression therapies have become increasingly popular for use in outpatient orthopaedic and sports medicine facilities following injury or  orthopaedic surgery.

While these devices can provide a convenient and efficient means of delivering a combination of cryo and compression therapy, appropriate and sufficient coding and billing requires careful consideration.

Medicare and most commercial payers do not pay for cryotherapy (97010) and, if paid, the amount is typically nominal. Medicare and many other payers do pay for vasopneumatic compression (97016), but generally only for managing swelling or lymphedema.  When coverage for vasopneumatic compression exists, insurance carriers typically expect documentation of medical necessity for the modality to include pre- and post-treatment girth measurements, as evidence that the vasopneumatic device is indicated. Additionally, based on the clinical condition of the patient, monitoring of vital signs may be required to ensure that there are no complications from facilitating the lymphatic flow.  Pre- and post- treatment girth measurements, and vital sign monitoring when indicated, and a demonstration of improvement in girth measurements should be made over the time that the device is being billed to demonstrate medical necessity. Indeed, insurance carriers have flagged vasopneumatic charges and have successfully denied payments for treatments that are not supported by pre- and post-treatment girth measurements.

In addition, some insurers are simply not paying for vasopneumatic devices.  For instance, Aetna considers active cold compression therapy units with mechanical pumps and portable refrigerators (e.g., AutoChill, Game Ready, IceMan, NanoTherm, Prothermo, and Vascutherm) experimental and investigational because they have not been proven to offer clinically significant benefits over passive cold compression therapy units.

If you are using vasopneumatic devices, such as Game Ready, it is important to determine which insurers will simply not pay for this treatment. For the insurers that do pay, it is imperative that you understand what must be documented to evidence medical necessity for coverage of the device.