American Medical Association (AMA) coding guidelines dictate that it is only appropriate to bill for Chiropractic Manipulative Treatment (CMT) and manual therapy (CPT code 97140) for the same patient on the same visit under certain circumstances. Therefore, some payers have installed an edit, bundling these codes and only consider payment after submission and approval of medical records. Other payers identify high utilizers of these joint CPT codes, triggering an audit. The goal of this article is to assist you with proper usage and documentation of these codes, so that, if an audit, or record review arises, you are prepared.
CPT defines or categorizes spinal body regions into the following:
Additionally, CPT defines or categorizes extraspinal body regions as follows:
- Upper extremities
- Rib cage
- Lower extremities
Based on CPT guidelines, CMT and manual therapy should only be billed to payers when manual therapy is performed in a body region, which is separate from CMT (See above definitions). The records need to support medical necessity for the use of both CPT codes as well. In addition, manual therapy as a timed code, is required to be performed for a minimum of eight minutes to bill one unit. If all criteria are met, both codes could be billed, and a -59 modifier should be appended to 97140.
Typical manual therapy techniques used in a chiropractic office consist of soft tissue mobilization, manual lymphatic drainage, manual traction, myofascial release and neural gliding techniques.
There are a couple of scenarios where it would be appropriate to bill both CPT codes:
Example One: The patient enters the office with complaints of neck pain, middle back pain and lower back pain. The provider’s examination reveals segmental dysfunction is present in the thoracic and lumbar spine and there are muscular spasms and muscular tightness in the cervical paraspinal muscles. The provider treats this patient with a
2-level CMT (98940) in the thoracic and lumbar spine. In addition, manual therapy is performed to the cervical paraspinal muscles for eight minutes. In this instance, it would be appropriate to submit the following:
- 97140-59- 1 unit
Example Two: The patient enters the office with complaints of lower back pain and right hamstring muscle tightness. The patient runs three miles twice weekly and noticed these symptoms three weeks ago after running. Examination reveals segmental dysfunction in the pelvis, sacral area and lumbar spine. In addition, there is significant tightness and tenderness of the right hamstring muscle. The provider treats this patient with a 3-level CMT (lumbar, sacrum, pelvis) and performs manual therapy for ten minutes on the right hamstring muscle. It would be appropriate to bill the following:
- 97140-59- 1 unit
To ensure the proper claim submission of CMT & manual therapy on the same visit for the same patient, these services must be performed in separate body regions, medical necessity rationale must be documented for the use of both codes and manual therapy must be performed for a minimum of eight minutes. If these standards are not met, justification for use of both codes on the same visit is not present. Make sure that all pertinent items are documented in the medical records. This will ensure that if an audit is performed, your documentation supports the use of these codes.