3-19-01 Shared by Dr. Sigmund Miller To receive his timely e-mails contact him at: webinfo@chiroviewpresents.com Using 98940 & 97140 Codes During the Same Visit Sigmund Miller, DC Editor - CVP This is 1 of 2 short articles presented on this topic in this week's broadcast. The other is an excellent piece authored by Thomas Freedland, DC - CVP head of the Utilization Review Department. This is one of the more frequently asked questions I get as a result of the CVP broadcast: "Can I use CPT codes 98940 and 94170 during the same visit? I broadcasted on this topic last year so I will just summarize key points. Generally speaking, chiropractors are submitting their bills correctly. Most often payers are getting inaccurate information from their supervisors or are rejecting these bills by relying on software programs designed to deny these services whenever submitted on the same visit. Remember codes 98940-98943 are not time -based and each includes an evaluation - management [EM] component consisting of chart review, care planning, pre and post manipulative procedures, assessment of treatment, chart documentation, consultation and reporting. As an a side, obviously when interim or final exams are completed, you need to use the appropriate EM code with modifier ie. 99213-25. Using -25 means you are providing an additional EM service over and above the pre and post-manipulative procedures typically completed on each visit. Using this modifier allows you to be properly reimbursed for these additional EM services. Code 97140 is time -based [15 minutes increments] and includes manual traction, myofascial release, soft tissue manipulation; spinal manipulation and joint mobilization. The confusion is code 97140 also includes 98940-98943 services, ie adjustment/spinal and extremity manipulation. As a result, using them together can appear as duplication of services. Well maybe not! I have spoken to many payers on this issue. Following my explanation, they are in a better position to authorize care if it is presented in the following ways: Let's say you adjusted the cervical region using code 98940. During the same visit, if you also treated the lumbar region or limbs for 15 minutes using various manual techniques as listed above, then 97140 should be submitted along with the -59 modifier. The -59 indicates that you are "providing separate and distinct services not often performed together". Another scenario that can raise a "red flag" includes using these two codes when treating the same region. To solve this, again use the - 59 modifier indicating that the adjustment should not be considered as part of 97140 services. For example, the chiropractor can use codes 98940 and 97140-59 directed to the lumbar spine that includes, the adjustment [98940], along with 15 minutes of mysofascial release and flexion traction [97140]. If the latter procedures took 30 minutes, than use 97140 x 2. Bottom line...make sure your daily charting confirms that you are performing separate and distinct services when using 98940 and 97140-59 codes during the same visit. Hope that helps. ____________________________________ Confusion: Codes 97140 v 98940 Thomas Freedland, DC CVP Department Head - Utilization Review Tfreedland@aol.com It's January 2001, two years since the introduction of CPT code 97140 and there is still confusion as to its proper use. 97140 came into being as a compromise during the 1998 CPT committee meetings. The physical therapists had lobbied for a staggered or progressive code similar to the chiropractic manipulative therapy codes and the osteopathic manipulative therapy codes. However, what resulted was a compromise that nobody wanted. Gone were the old manipulation codes (97260, 97261), joint mobilization (97265), manual traction (97122), and myofascial release (97250). In their place was a single code (97140) defined: Manipulation, Mobilization, and Other manual therapies. Many insurance companies took the position that manual therapy and chiropractic or osteopathic manipulation was duplications of service since manipulation was in the definition of 97140. This ignored the fact that the new code encompassed a variety of procedures, only one of which was manipulation. Further, CPT had previously accepted the distinction between chiropractic manipulation (98940-98943) and the previously used manipulation (97260). To confuse matters further, HCFA (Health Care Finance Administration), which administers Medicare and helps establish certain guidelines, violated their own rules by defining manual therapy (97140) as a duplication of chiropractic manipulation. Where does that leave the poor practitioner? Many patients present with conditions that warrant specific soft tissue therapy in addition to chiropractic manipulation. Conditions such as myofascitis and trigger points may require a significant amount of therapy in order for the manipulation/adjustment to be fully effective or to have the most benefit. This is a procedure that is more than just preparatory for the chiropractic manipulative therapy. But how does the treating practitioner bill for such services? The answer is far from cut and dried. The addition of modifier-59 has been suggested and used with some success when billing certain insurance companies, especially many PIP/Med-Pay carriers. Modifier-59 is titled: Distinct Procedural Service. The definition reads, "Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier-59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances." The definition also tends to suggest that the distinct service should be to an additional region not treated with manipulation. However, this would be a gray area. Still, this tactic does not work for all insurance carriers. In such cases, massage therapy (97124) might be an effective but less descriptive alternative, as is 97139 - unlisted therapeutic procedure. The drawbacks being massage therapy is not always a covered benefit and the unspecified therapeutic procedure mandates an explanation of the services performed. Additionally, both usually have a lower level of reimbursement. Regardless of the code used, the provider must provide adequate clinical documentation (chart notes) to support the services billed. Providers must come to the realization that there is no completely correct answer. Perhaps the safest option, although not without pitfalls, is to add a step in the insurance verification process. Specifically, when the front office calls to determine what benefits a particular patient has, a brief discussion of what secondary CPT codes will be accepted can be made. This is not completely fool proof since most insurance companies include a disclaimer when providing specifics regarding a policy. However, it at least gives the provider more credibility when disputing the reduction in reimbursement for non-covered services. What might be a more effective long-term solution would be to request through the chiropractic representative on the CPT panel a re-institution of myofascial release (97250). Until such time that manual therapy can be better clarified and the conflicts reduced, the solution to these billing problems are mixed depending on the insurance company involved. ______________________