RE: Iontophoresis

[Guest guest]

Hi everyone,

Any discussion on iontophoresis brings up some points to be made:

1. For reimbursement questions, you have to check each insurance's

policy (or have your billing department do it). Medicare payment will

depend on the LCD (local coverage determination) for the contractor that

your state uses. Some Medicare contractors pay for ionto, some do not. The

specifics of what they pay for should be in the LCD. I have not heard of

them only paying for 2 visits. If this is a new policy then there should be

a communication from the contractor to your billing department about it.

Otherwise the LCD is still the policy in place. It is good for those that

see Medicare outpatient, Part B, even if you are hospital-based, to be aware

of and read the LCD for your contractor as well as Part B Medicare Benefits

Policy. It helps put Medicare policy into perspective and give you a better

understanding of payment issues with Medicare including iontophoresis. BUT

it is contractor specific for LCD's so you would have to look up your local

LCD. Same goes for other insurances: you have to know the coverage policy

on ionto for each insurance. I would suggest that if your department uses

iontophoresis on a regular basis, consider having your billing department or

person make a list for PT staff listing who pays and who doesn't, what the

coverage is etc. This will help reduce using ionto only to find out that

payment is denied.

2. Be careful about the medication. Very few states have laws in

their PT statutes that govern medication. These are normally found in the

Pharmacy Board or Medical Board laws and generally are very specific on the

prescription of, storage of and use of medications. From past discussions

and from my clinic's experience, we work with patients and their doctor to

get a prescription for any medication used in therapy including

Dexamethasone. We are an outpatient private practice so hospital-based

clinics will have different policies based on accrediting bodies like JCAHO

and state laws. We will use the medication only for that patient. It helps

to have a compounding pharmacy in the area to get the correct compound or

medication for therapeutic use once we have a prescription. We do not store

medication after patient discharge and dispose of it properly. We have to

do this because the local pharmacy laws prevent us from getting and using

medication without a prescription. Bottom line, check the PT statutes and

if nothing is there regarding medications then check the Pharmacy or Medical

Boards and be careful to follow the appropriate laws for your state.

3. As far as delivery systems, I have seen or heard of using Hybresis

and standard machines. The research is mixed on whether Hybresis is any

superior to standard practice except in the time and cost saving (as the

cost is passed on to the patient if insurance doesn't cover). Both systems

work, just depends on what your clinic can afford in start-up costs (the

Hybresis units are expensive), time use and type of patients that you use

iontophoresis with. Hybresis does have an advantage of being easier for

home use as well.

4. I always remind people that clinical decision making using

evidence-based practice should be the first thing to guide your use of

ionto, not payment. If your judgment and the evidence point that

iontophoresis is the best treatment for a particular impairment, then

discuss it with the client. We(our profession) often sell good treatments

short because they are not paid for when we should be trying to use the best

treatments no matter what. Despite what insurances say, iontophoresis is

NOT investigational for a number of problems and there is evidence that it

is effective. From Medicare patients without coverage, remember to fill out

an ABN form and for other insurances with no coverage, make sure you discuss

it with your patients and offer them the choice. We have had a number of

patients, when given the choice, opt to pay for the treatment in those cases

where the evidence supported its use.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of Libolt, Lori F.

Sent: Monday, May 23, 2011 11:44 AM

To: 'PTManager '

Subject: RE: Iontophoresis

Hi ,

Good question. I would also like to add to this: Are clinics requiring

patients to get their own prescription or does the clinic stock the

medication? ( we mostly use dexamethasone and require the patient to get

their own prescription). We have tried, unsuccessfully, to find out by our

state PT board if we can keep the medication in the clinic name and provide

it for patients when we have a prescription for ionto. I was of the

understanding that iontophoresis was not covered by insurance. We ask the

patient to purchase the electrodes each visit and do not charge for the

visit.

Lori Libolt, OTR/L,CHT

ReBound Physical, Occupational, and Hand Therapies

805 Orchard Drive Suite2

Bellingham, WA 98264

360 752-1575

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf Of Thagard

Sent: Monday, May 23, 2011 7:08 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Iontophoresis

What is everyone using for Iontophoresis these days... Are you doing Ionto

in the clinic ? Is the patient using patches at home? If so, how are you

supplying them?

I was told by a consultant that Medicare is only paying for 2 iontophoresis

visits in the clinic because of the widespread use of the patches at home.

Thagard

Director, Rehabilitation

Sampson Regional Medical Center

405 Beaman St

Clinton, NC 28328

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