Manipulative Treatment And Manual Therapy With The 97140 CPT Code
American Medical Association (AMA) coding rules record that it is only suitable to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under specific situations. Hence, some payers have placed an edit, bundled these codes, and only consider payment after submission and approval of medical records. Other payers identify high users of these joint CPT codes, set off an audit.
97140 CPT CODE: MANUAL THERAPY
97140 CPT code description is about Manual therapy techniques such as mobilization/manipulation, manual lymphatic drainage, manual friction for one or more regions. It’s also additionally described to include things like manual trigger point therapy and myofascial release. Manual therapy techniques treat the limited motion of soft tissues in the extremities, neck, and trunk. The following description form more detail about manual therapy:
- Manual therapy is used actively and passively to help effect changes in the soft tissues, articular structures, and neural or vascular systems.
- The service expects to increase pain-free range of motion and aid a return to functional activities.
- An example is the restoration of movement in sharply edematous muscles or stretching of shortened connective tissue.
- Manual therapy is used when a loss of motor ability impedes function.
- The National Correct Coding Initiative (NCCI) edits created by the Centers for Medicare and Medicaid Services (CMS) require that the manual therapy techniques be worked in a different anatomic site than the chiropractic adjustments to reimburse separately.
MANUAL THERAPY AND CHIROPRACTIC ADJUSTMENT CODES
Chiropractic adjustments have their codes (98940-98942, or 98943). If you report a subluxation diagnosis code, you need to perform an adjustment. National Correct Coding Initiative (NCCI) claims to edit bundle manual therapy (97140 CPT Code) to chiropractic adjustment codes (98940-98942) when performed in the same anatomic region. If the procedures perform in separate anatomic areas, you may report them separately by appending modifier 59 to the adjustment code. If the claim is filed correctly and supported by documentation, the insurer should pay for both methods. The provider’s notes should include the below details for making the payment successfully:
- Signs for treatment (manual therapy)
- Treatment goals incorporated with manual therapy services
- Objective measures used to assure patient improvement in treatment objects
- Improvement towards treatment goals
- Which places, respectively, were treated with manual therapy and with your chiropractic adjustment; these areas should not correspond if you want to receive separate reimbursement.
- Treatment plan (include frequency and duration)
CPT 97124 VS 97140
97124 CPT Code is about Therapeutic procedure, one or more areas, massage. Massage is known as a therapeutic procedure which is a time-based service. A restorative procedure defines as effecting change by applying clinical skills and services to improve function. Therapeutic strategies require direct one-on-one patient contact by a physician or therapist and can only perform by the doctor or an adequately licensed therapist.
Code 97124 often prescribes for the rubbing-based, relaxation type massage that might be less specific than 97140. With Manual Therapy, one would hope to see the services ordered to approach the objective loss of joint motion, strength, or mobility. They should be part of an active treatment plan directed at a particular outcome. For example, ‘97140 CPT Code prescribes increasing the flexibility of the quadratus lumborum muscles to help improve the patient’s capacity to walk up to a mile and stand longer than one hour at their job’.
The early years of the 97140 code
The old code 97150-Myofascial Release, which many providers used for trigger-point therapy, was billed along with the CMT code for any muscle work performed in combination with the adjustment. But, with the CPT update in 1999, more clarity appeared about what was included and what wasn’t.
Many payers took the position that 97140 was considered “mutually exclusive” with the CMT service in many circumstances. As a result, providers advise using the 59 modifiers when providing both CMT and 97140 to delineate that the services were separately identifiable. That was supposed to mean an individually identifiable area for the 97140 vs. the CMT service. However, that was not always the fact.
Some providers performed both in the same anatomical region and billed with the 59 modifiers anyway. Then, upon audit, it explained that the providers billed using the 59 modifiers when the service doesn’t perform in separate regions. Since so many providers find to have “done it wrong,” a knee-jerk reaction happened when some payers never covered both CMT and 97140 on the same visit. With clear documentation of the separately identifiable regions, only in appeal would the 97140 CPT code service be paid.
The 97140 CPT Code: 2021
Some payers, like Optum, have finally taken the guesswork out of when and how to append the -59 modifier when performing CMT along with procedure code 97140 – manual therapy techniques.
But, many providers are working as in the past. They are unaware of the rules they expect to follow when billing both. Some, like Optum, have defined their behavior for when both services are billable and payable.
A member who deals with Optum as the payer for Veterans Affairs (VA) patients is now dealing with this situation. Unfortunately, they hadn’t kept up with the rules and were billing both services at the same time incorrectly. So far, almost $20,000 has been recovered from the provider due to billing errors.
A summary of Optum’s policy on CMT/97140
Manipulation and Manual Therapy CPT code 97140 might be billed on the same service date as a CMT code when the manual therapy service provides to a different, removed body region than the CMT. Therefore, CMS has set the following four HCPCS modifiers to define specific subsets of the -59 modifier: XE Separate Encounter; XS Separate Structure; XP Separate Practitioner; XU Unusual Non-Overlapping Service.
The National Correct Coding Initiative (NCCI) Edits – developed by the CMS – guides the application of modifier – 59. Different diagnoses are not acceptable standards for the use of modifier -59. Therefore, the HCPCS/CPT codes remain bundled unless the procedures/surgeries are performed on various anatomic sites or during separate patient encounters.
From an NCCI perspective, the definition of different anatomic sites includes other organs or different lesions in the same organ. However, the treatment of contiguous structures in the same organ or anatomic region does not constitute the treatment of various anatomic sites.
You can append either the -59 modifier or the X modifiers; both are accepted forms of billing at this time. But what about the reference to the noncontiguous body region? To understand Optum’s interpretation of body regions, we should start with what is considered a “region” when reporting CMT. The policy says:
“To report CMT codes, there are five spinal regions and five extraspinal regions. The spinal regions are cervical, thoracic, lumbar, sacral, and pelvic. The extraspinal regions are head; lower extremities; upper extremities; rib cage.”
Notice how Optum pulls it all together. First, Optum clarifies contiguous and noncontiguous body regions as follows:
“The treatment of myofascial structures using manual therapy techniques in the same organ, where CMT was performed and was contiguous (cervical and thoracic), does not establish the treatment of different anatomic sites.
The treatment of myofascial structures using manual therapy techniques in the same organ, where CMT was performed and was not contiguous (cervical and lumbar), forms treatment of different anatomic sites.
The treatment of the cervical spine and a shoulder joint does constitute treatment of different anatomic sites.”
Compliance with billing/documentation rules
Most payers publish their Medical Review Policy (MRP) for such things, and providers who bill the payer should take heed of the rules of the game. These are essential factors to review before billing these services, ensuring that the clinical record matches the CPT codes billed:
- Manipulation was not performed to the same anatomic region or a contiguous anatomic region (e.g., cervical and thoracic areas were adjacent; cervical and pelvic regions were noncontiguous)
- The clinical explanation for a separate and identifiable service must be documented (e.g., contraindication to CMT is present)
- Description of the manual therapy technique(s) location (e.g., spinal region(s), shoulder, thigh, etc.)
- Time (e.g., number of minutes spent performing the services associated with this procedure) meets the timed-therapy services requirement
- The 97140 CPT code append with the modifier -59 or the appropriate -X modifier
If you are billing 98941 with 97140, you may notice it is tough to satisfy all of the criteria listed above. In addition to documentation, ensure your billing is consistent with the reason for performing 97140 by pointing to the correct diagnosis code. The reason for performing CMT should never be the same as 97140 when billing.
How would you answer these questions?
Considering the increasing scrutiny and number of audits, it’s better self-check to make sure you have what’s necessary to bill both CMT and 97140 on the same visit properly:
- Is the manual therapy performed as a pre-cursor to the adjustment in the same or a contiguous body region? Then, it would be best if you did not charge for both.
- Is the manual therapy performed in a separate, noncontiguous body region? If so, make sure you have different diagnoses, document both conditions, and include both services in your treatment plan at the beginning of the episode of care.
- Do you use diagnosis pointers when listing the procedure 97140 CPT code? If so, are they pointing to a similar diagnosis as the CMT?
If you regularly perform both CMT and 97140, make sure you consider the coding guidelines provided by the payers with whom you deal. In addition, look for MRP that describes their rules for billing both services and what they expect in the documentation.
How to apply 97410 properly?
Per CPT guidelines, 97140 is about manual therapy techniques, like mobilization and manipulation, manual lymphatic drainage, and manual traction. In addition, chiropractic adjustments have their codes (98940-98942, or 98943 for an extremity). Therefore, if you report a subluxation diagnosis code, you should perform an adjustment.
National Correct Coding Initiative (NCCI) requires to edit bundle manual therapy (97140) to chiropractic adjustment codes (98940-98942) when performed in the same anatomic region. If the procedures perform in separate anatomic areas, you may report them separately by appending modifier 59 to the adjustment code. If the claim is filed correctly and supported by documentation, the insurer should pay for both methods.
Example 1: The chiropractor makes chiropractic adjustment (98940 Chiropractic manipulative treatment (CMT)) on the cervical region. He then performs manual therapy (97140) to the same cervical region. However, the patient’s diagnosis codes reflect cervical subluxation and muscle contractions. Therefore, the manual therapy (97140) would not be reimbursable in this scenario.
Example 2: The chiropractor conducts chiropractic adjustment (98941 Chiropractic manipulative treatment (CMT)) on the cervical and lumbar regions. They then perform manual therapy (97140) on the patient’s shoulder. The patient’s diagnosis codes are cervical subluxation (739.1), lumbar degenerative disc illness, adhesive capsulitis, and muscle spasms (728.85). The diagnosis pointers connect the manual therapy (97140) to the diagnosis codes adhering to capsulitis (726.0) and muscle spasms (728.85). In this situation, the manual therapy would be separately reimbursable if reported with modifier 59 added.