10-13-00 .. from: Sigmund Miller, DC Webinfo@chiroviewpresents.com ChiroView Presents - Codes 98940 v 97140 / What is the difference and why cant I get paid? Author: Sigmund Miller, DC If you are not interested in receiving the ChiroView Presents weekly broadcast, please click your reply button and write „off¾. During the past two months, more than ever before, I¼ve been requested to clarify some confusion and inconsistencies relating to CPT codes 98940 v. 97140. I¼ve broadcasted on this topic previously and thought it would be useful to share these points again along with some updated information. I have also included summaries regarding modifiers. I hope you find this information helpful. I continue to post many articles to the 50 Clinical Department Boards. I do appreciate your kind words in how much you are enjoying this format. Just go to http://www.ChiroViewPresents.com and click „clinical departments. This broadcast is supported by Clinic Pro Chiropractic Software. You can check them out @ http://www.ClinicPro.com. If you your company is interested in supporting this effort, just send me an e- mail. By the way, I will have the opportunity to present at Maine¼s upcoming state convention held in Portland on October 21 & 22. Hope to see some of you there. You can contact John Royce for more information. Here you go - I have been requested by insurance companies and chiropractors to provide some feedback as to how and when CPT codes 98940-43 and 94170 can be used during the same visit. Using proper CPT coding and modifiers have been a problem for many chiropractors since their bills typically are not getting paid. I have spent a great deal of time addressing this and other related coding issues. As a general rule, the doctor is submitting their bills correctly. In contrast, generally speaking the payer doesn't understand what's really going on here. They are relying upon newly - released software programs that is designed to simply deny services whenever 98940‚43 and 97140 codes are used during the same office visit. Codes 98940-98943 refer to spinal/extremity manipulation, where selection depends upon number of regions treated. 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. Obviously when interim or final exams are completed, you need to use the appropriate EM code with modifier ie. 99213-25. The -25 illustrates that 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. Rememberäthe 98940-98943 series "are not time -based". Code 97140 is time -based [15 minutes] and replaced codes 97122- manual traction; 97250-myofascial release / soft tissue manipulation; 97260-61 -spinal manipulation; and 97265-joint mobilization. Here's the problem...code 97140 includes all 98940-43 services, as well! Therefore using them together can appear as "duplication of services...right? Maybe "yes"...maybe "no". Here's what you can do. If you treat the cervical region with 98940 and the lumbar region or limbs for 15 minutes using various manual techniques as listed above, then 97140 can be used with the -59 modifier. The -59 indicates that you are "providing separate and distinct services not often performed together". Here's another scenario that's OK but can potentially trigger claims...98940 and 97140-59 directed to the lumbar spine which included 15 minutes of mysofascial release and flexion traction therapy. Perfect! Here's the big problem...let's say that services, consistent with code 98940, were directed toward the cervical region and accompanied code 97140-59 which included nothing more than pre/post manipulative procedures which probably took less than 5 minutes. C'mon...you all know what I'm talking about. Here's what's important...in this situation 97140 -59 was not a separate and distinct procedure but was part of CMT. By the way, if the procedure takes 30 minutes then use 97140 x 2. If you worked on the patient for 20 minutes, then use 97140 and 97140-52 [the -52 modifier indicates one of the units of time was less than 15 minutes]. 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. As always, I ask that you rate the broadcast 1-5 [1=I'm putting you to sleep and 5=great stuff]! Here is the summary on using some of the more common modifiers: Modifiers - 1. -25 Use this modifier with all initial-interim-final EM codes ie 99203-25 or 99213-25 in combination with CMT codes [98940- 43]. This indicates that EM services provided by you went beyond the typical pre and post EM services that are an integral part to all CMT codes. This allows you to submit additional fees for services provided. EM codes should be submitted in timely fashion, such as when completing initial, interim, or final examinations or when there is a change in clinical status ie flare-up. 2. -59 Use this modifier when combining services not typically scheduled together, for example codes 98940 along with 97140-59. When using ‚59, you are indicating, based upon clinical diagnosis, that additional manual therapies [ie myofascial release] were required independent of CMT procedures. Remember that code 97140 is a time-driven procedure [15 minutes] and CMT codes are not. For additional information on this topic, please refer to the previous broadcast that addressed this issue, in depth. Most importantlyäyou can use these codes during the same office visit when treating the same spinal regions and don¼t let the insurance company or payer representative tell you otherwise. When using these codes in combination, I do recommend that your daily charting confirm what was done and how long it took to do it. 3. -51 Use this modifier to indicate which one of two procedures completed during the office visit was not the primary procedure. The most common example is when scheduling spinal manipulation [98940] in combination with extremity manipulation [98943-51]. I rarely see the ‚51 modifier being used. 4. -52 Use this modifier when less than full service or increment of time was used. For example, if myofascial release was applied for 20 minutes, consider using 97140 [15 minutes] and 97140-52 [5 minutes], or 99214-52 when re-exam took less than 25 minutes but more than 15 minutes [99213]. 5. -26 Use this modifier when prescribing radiographic work-up and using an outside facility to take the films; for example 72100- 26 indicates you have provided the professional component [interpretation and reporting to patient] and the technical component [taking the x-ray] was performed by others. 6. -21 Use this modifier when prolonged service offered is greater than the highest CPT level offered ie 99215-21. Although the ‚21 modifier is intended for this purpose, I have never reviewed a case when it was used. I believe this could potentially red flag your file. My recommendation is to stay away from it. To become a member subscriber click http://www.ChiroViewPresents.com Cheers! Sigmund Miller, DC Webinfo@chiroviewpresents.com