Let's face it, sometimes in a chiropractic office it can be difficult to know exactly which code to use for services rendered. You try a Google search, ask your colleagues, and sometimes choose a code based on which reimbursement might look the most inviting. But you must remember that coding accurately isn't based on a nice reimbursement or what seems to be "getting paid," but on a structured set of explanations and descriptions that point you to the best code available for the service you offer. Codes that are being paid today could provide the funds that may be taken back tomorrow. We have all heard about recoupment requests that are showing up everywhere. As billing specialists, it's our job to help the doctor understand how to translate the work done into the right code to bill. One of the more difficult coding scenarios to navigate is understanding when the manual muscle work being delivered should be described as "massage therapy" and when it should be noted as "manual therapy." The following information will help to translate and offer you a better understanding of the differences between the two services. CPT Code 97124- Massage Therapy: The American Medical Association's (AMA) CPT 2013 (current procedural terminology) edition describes 97124 as, "Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage, and/ ortapotement (stroking, compression, percussion)." Massage therapy could be included as part of an active treatment plan with specific deficits and goals associated with the massage. Some of the more common goals we see for massage therapy can include restoring muscle function, decreasing specific stiffness, reducing documented edema, improving joint motion by degrees, or for relief of muscle spasms. The prescription of massage therapy should come with expected outcomes, and the objective measures that will be used to evaluate the effectiveness of the treatment. It would also be prudent to have specific diagnosis codes linked to the massage procedure for clarity. Doctors are cautioned against prescribing massage therapy for relaxation, stress relief, and other clinically appropriate but perhaps not medically necessary reasons when seeking reimbursement from a third-party payer. Third-party reimbursement of massage therapy is highly scrutinized when prescribed over long periods, with multiple, nonspecific units of time billed per session. The following descriptors outline more detail about massage therapy: Massage therapy includes effleurage (circular movement), petrissage (lifting, squeezing), and tapotement (stroking, compression, percussion). The intent of the service is to increase circulation and promote tissue relaxation of the muscles, and the treatment is based on or consists of more basic massage. When billed on the same visit as a chiropractic manipulative treatment code (98940 to 98943), carriers often require the -59 modifier appended to the 97124 code to clarify that it's a distinct and separate procedure from the adjustment. CPT Code 97140 - Manual Therapy Techniques: The AMA's CPT 2013 edition describes 97140 as, "Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes." Also, 97140 has been further described to include things such as manual trigger point therapy and myofascial release techniques. Manual therapy often is used to treat restricted motion of soft tissues in the extremities, neck, and spinal regions. The following descriptors outline more detail about manual therapy: Manual therapy is used in an active or passive fashion to help effect changes in the soft tissues and articu lar structures. The intent of the service is to increase pain-free range of motion and facilitate a return to functional activi ties. An example is the fa cilitation of fluid exchange, restoration of movement in acutely edematous mus cles, or stretching of short ened connective tissue. For example, manual therapy can be used when a loss of motor ability impedes function. The National Correct Cod ing Initiative (NCCI) edits created by the Centers for Medicare and Medicaid Services (CMS) require that manual therapy techniques be performed in a sepa rate anatomic site from chiropractic adjustments in order to be reimbursed separately. Therefore, if you do this, append the -59 modifier to 97140 in order to indicate that it is a distinct procedure and is being performed at a differ ent anatomic region than the chiropractic adjust ment that day. Only under very specific circumstances would we expect to see someone bill a 98941 on the same visit as a 97140 to a third-party payer. Which Should I Use? A study was conducted among licensed massage therapists who claimed to be perform- ing both manual therapy and massage therapy in the same session. An observer was unable to tell the difference between the two services when the LMT changed from one to the next. This illustrates the point that the service may look very similar, but the difference is clarified in the documentation. The treatment plan for the episode of care must reflect the recommended service, along with the projected outcomes and goals of the treatment. Based on the two definitions above, the intent of the service is clearly different between the two. The code 97124 is often prescribed for the friction-based, relaxation-type massage that may be less specific than 97140. With manual therapy, one would expect to see the services ordered to address objective loss of joint motion, strength, or mobility, and they must be part of an active treatment plan directed at a specific outcome. For example, stated goals could say, "97140 is prescribed to increase flexibility of the quadratus lumbo-rum muscles, while activating and stretching the hamstring muscles, to help improve the patient's capacity for walking up to a mile and standing longer than one hour at work as a cashier." Daily, routine visit documentation of the two services should also include progress toward those stated goals. Third-party payers often have very specific medical review policy regarding both 97124 and 97140. When providers wish to order and deliver either service, it's vital that they clearly understand the rules that apply to this service. For example, Federal Blue Cross and Blue Shield review policy indicates that any type of muscle work (97124 or 97140) is reimbursable only when provided by a licensed DC, PT, or MD. If the work is delegated to a licensed massage therapist or other unlicensed provider, it's not payable. If you intend to bill these services to a third-party payer, it is important to get clarification when calling to verify insurance benefits for the patient. You will want to ask questions such as: Is either 97124 or 97140 covered when delegated to a licensed massage therapist? Does the policy require that the doctor perform these services? 97124? 97140? Must I use the doctor's NPI when billing these sevices? 97124? 97140? Is 97124 only covered when billed underthe licensed massage therapist's NPI? Unfortunately, some providers abuse the medical payment system for the short-term gain by offering nonmedically indicated massage and seeking third-party reimbursement. In the long term, this damages all providers by causing third-party payers to review these instances and claims. When they see a large majority of error rate, they will often remove the code from their coverable services, making it available to no one. This does harm to the majority of providers who carefully evaluate their treatment plans and only order manual muscle therapy within these rules of CPT coding, using careful, ethical judgment. Make sure that your office fully understands the definition of every CPT code being billed, and how to communicate the services to the third-party payers. You deserve to be paid fairly for the services you offer, and using the most accurate code for each service ensures you not only get to make more money, but keep it as well. KathyMills Chang is a Certified Medical Compliance Specialist (MCS-P) and. since 1983. has been providing chiropractorswitli reimbursement and compliance training, advice and tools to improve thefinancialperformance of their practices. Kathy is known as one of our profession's foremost experts on A ledicare andean be reached at (855) TEAMKMC or mfo(cvj<mcuniversity.com
