Diathermy eg Microwave Use and Documentation

January 4th, 2018 - Find-A-Code
Categories:   CPT® Coding   Physical Medicine|Physical Therapy   Billing   Documentation Guidelines  
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According to CGS Administrators, the objective of these treatments is to cause vasodilation and relieve pain from muscle spasm. Because heating is accomplished without physical contact between the modality and the skin, it can be used even if skin is abraded, as long as there is no significant edema.
Diathermy achieves a greater rise in deep tissue temperature than microwave. As diathermy is considered a deep heat treatment, careful consideration should be given to the size, location and depth of the tissue the diathermy is intended to heat. For example, it may not be appropriate to perform diathermy treatment to the wrist or hand as most intended tissues would be considered superficial and the area is relatively small.
Diathermy may be indicated when a large area of deep tissues requires heat. It would not be reasonable and necessary to perform both thermal ultrasound and diathermy to the same region of the body in the same visit as both are considered deep heat modalities.
Pulsed wave diathermy is covered for the same conditions and to the same extent as standard diathermy. (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Section 150.5)

Both standard and pulsed wave diathermy are contraindicated in the following settings:

  • Malignancy;
  • Sensory loss; Tuberculosis;
  • Metallic implants or foreign bodies;
  • Pregnancy;
  • Application over moist dressings; Ischemic areas or arteriosclerosis; 
  • Thromboangiitis obliterans;
  • Phlebitis;
  • Cardiac pacemakers or other such implanted devices (e.g. pain pumps); 
  • Contact lenses or other ocular use;
  • Metal-containing intrauterine contraceptive devices;
  • Metal in contact with skin (eg, watches, belt buckles, jewelry); 
  • Use over epiphyseal areas of developing bones;
  • Active menses;

In addition, extreme care must be used with pediatric or geriatric patients.

Diathermy is not considered reasonable and necessary for the treatment of asthma, bronchitis, or any other pulmonary condition. (CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Section 240.3) Microwave is not a covered service.

Only 1 unit of CPT code 97024 is covered per date of service. If no objective and/or subjective improvement are noted after 6 treatments, a change in treatment plan (alternative strategies) should be implemented, or documentation should include the therapist’s rationale for continued diathermy. Documentation must clearly support the need for diathermy more than 12 visits.
Supportive Documentation Recommendations for 97024

  • Area(s) being treated
  • Objective clinical findings/measurements to support the need for a deep heat treatment
  • Subjective findings to include pain ratings, pain location, activities which increase or decrease pain, effect on function, etc.

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