Chiropractic Continuing Education: Navigating the 97140 CPT Code for Manual Therapy and Manipulative Treatment Posted on Oct 18, 2023
CCEDseminars | Your Prime Source For Chiropractic Continuing Education!Navigating the billing maze in chiropractic care can be a complex endeavor. One of the most frequent questions asked in chiropractic continuing education programs like CCEDseminars pertains to billing both manipulative treatment and manual therapy under the 97140 CPT code. Let's explore this complex subject, especially for those keen on expanding their understanding through chiropractic continuing education.
The Evolution of the 97140 CPT Code in Chiropractic Care
During my time in practice, questions about the 97140 manual therapy CPT code have been common. It replaced five other codes in 1999, causing significant confusion among Doctors of Chiropractic (DCs). The previous code, 97150-Myofascial Release, often caused misunderstandings, particularly when billed alongside manipulative treatments.
The Troublesome Early Years of the 97140 Code
Initially, payers considered the 97140 code mutually exclusive with chiropractic manipulative treatment (CMT) in many situations. Providers had to use the 59 modifier to indicate that both services were performed in distinct anatomical regions. However, audits revealed that some providers billed both codes even when both were done in the same region, leading to recoupment of payments.
Clarifications in Billing Practices for 97140
Recent policies from payers like Optum have brought clarity. Now, certain modifiers, such as -59 or the X modifiers (XE, XS, XP, XU), can be used to specify non-overlapping services or separate anatomical regions. But even with these clarifications, some practitioners still make billing errors that can result in significant financial loss. Being up-to-date through chiropractic continuing education platforms like CCEDseminars can help avoid such pitfalls.
Understanding Payer Policies: A Case with Optum
Optum’s policy specifies that the 97140 code can be billed alongside a CMT code if the services are performed in separate, noncontiguous body regions. The policy lays out criteria for billing both codes:
- Manipulation should not be performed in the same or contiguous region as manual therapy.
- The clinical reason for both services should be distinct and well-documented.
- Both services should be listed with their respective duration and anatomical locations.
Compliance with Billing and Documentation Rules
For those keen on keeping their practice compliant and efficient, chiropractic continuing education can play an essential role. Make sure to follow guidelines published by payers and corroborate your billing with well-documented clinical records. Consistency between your documentation and the CPT codes you bill is crucial for avoiding issues during audits.
Self-Check Questions for Practitioners
- Is manual therapy performed as a precursor to the adjustment, and are they in the same or a contiguous body region?
- Is the manual therapy performed in a separate, non-contiguous body region?
- Are the diagnosis pointers used in the billing of 97140 pointing to different diagnoses than the CMT?
Keeping abreast of payer policies and coding updates through platforms dedicated to chiropractic continuing education, like CCEDseminars, will equip you to navigate the complexities of billing both manipulative treatments and manual therapy services.
In summary, understanding the intricacies of billing manual therapy and manipulative treatments under the 97140 CPT code is crucial. Ensure you're updated through credible chiropractic continuing education resources like CCEDseminars to avoid costly mistakes.
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