We understand the thrust to help your patients commit to and sustain a pain free, fully functional, and productive lifestyle, is of your practice’s highest order. Manual Therapies can be a stable and productive part of any type of practice, insurance or self-pay based. To implement them into and sustain your practice, doctors must be aware of how and when to communicate the different codes to any payer and reviewer.
Manual Muscle Therapy lives in the Physical Medicine bucket and encompasses various techniques for DC, PT, OT, and DO’s. Some non-traditional Chiropractic Adjustive Techniques may have enough peer reviewed research support to be covered as a Manual Therapy but not a CMT. Other techniques may overlap with CMT codes in the effect they impart to the NMS system, but do not completely fit into the CPT code. For example, Post Isometric Inhibition, Flexion Distraction, Instrument assisted therapies, joint and or soft tissue manipulation, trigger point therapy and others. They may find their coding home in a Manual Therapy code. Because of overlap of various muscle techniques, various rules exist to accommodate for this and make sure separation exists between them for coding and processing purposes.
One can easily see muscle therapies have potential to be seen as miscoded, used, and abused. Some of these common codes include 97124, 97140, 97110, 97112, 97139, 97799 and possibly others. One of the most common codes pertaining to Chiropractic practice may be 97140, so it will do doctors well to learn specifics of this, and other codes. You want to code to the highest specificity of procedures performed and documented, so you can get paid for the benefits you imparted to your patients, especially when it must stand up to an audit.
The goal is practice compliance and Provider Manuals are a part of it. They communicate their individual thresholds you should not cross so you can play and stay in the game. For example, BCBS of Kansas spells out how to avoid an audit for PHYSICAL MEDICINE practice. Pay special attention to the following bullets pertaining to Manual Therapies (in bold).
| BCBS of Kansas Audit Red Flags | |
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The take home message is Manual Therapies are frequently used in a spectrum of Chiropractic practices throughout the country and are part of many patients’ treatment plans. They should be coded and billed accordingly. Sometimes you may require assistance in knowing how and what to bill. KMC University is at the heart of helping you play and stay in the treatment game so you can be there for your patients with less stress. Call our HelpDesk with questions.
Have you thought about a baseline audit to see where your documentation and coding fall within the guidelines? We keep our education hats on with these teachable moments. Put us on speed dial and give us a call to schedule one!