Documentation Drives Coding

Download Support Tool Far too often, we find a fancy code (maybe a new code) and want to find a way to charge for it. This is completely backward. Documentation must drive coding. This simple visual reminder outlines the process of starting with the documentation and coding from there. Utilize this concept to reinforce the...
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Medicaid Reference Documents

Download Reference Documents Most of the resources a clinic will need can be found on the dedicated Medicaid website for their state. Listed below are some resources developed by CMS that can assist with understanding key aspects of the Medicaid program. How to Use the Medicaid National Correct Coding Initiative (NCCI) Tools Medicaid Provider Enrollment...
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Manual Therapies, Play and Stay in the Game

Manual Muscle Therapy lives in the Physical Medicine Bucket

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
  • High utilization
  • Billing/use of 97164 for DOS after Jan. 1, 2017 on each DOS billed
  • Repetitive services
  • Upcoding (e.g. 97032 instead of 97014)
  • Misuse of CPT codes
  • Billing/use of two or more superficial heating modalities to the same body part – Use of 97010, 97014, 97035 same body part, same session with no documented rationale and objective data to support necessity for each modality
  • Billing/use of 97124 and 97140 for the same body part on the same DOS
  • Continued use of modalities for periods greater than 10 treatment sessions with no documented rationale and objective data to support patient improvement and ongoing treatment.
  • # of units / treatment greater than BCBSKS policy allowable
  • Lack of treatment plan documented in medical record
  • Use of unlisted procedure and modality codes
  • Vague diagnosis codes

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!


Coding Therapeutic Activities – 97530

Therapeutic Activities – 97530 Therapeutic Activities are an asset to any office when coded and documented correctly. It is important to note that the guidelines for this code may vary, depending on individual state laws or provider contract provisions. Complete a Verification of Benefits for each patient to determine specific requirements. Guidelines are different if...
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Proper Use of S8990

Code S8990 & Maintenance Care Service codes (CPT/HCPCS) tell a third party what you are doing with the patient.  As with all coding, even maintenance care must be properly coded to clearly communicate in the patient record within your software, and for any authorized third-party that may have access to this data. S8990 Explanation Definition...
OOPS, this page contains content reserved for KMC University members. We’d love to welcome you to the KMC University family because there is an amazing amount of helpful content in the trainings and resources of the KMC University Library. Click here to learn more.

An Overview of CMT Coding

CMT Coding Expectations To set the stage for Chiropractic Manipulative Treatment (CMT) coding, we need to understand that these are procedurally encompassing codes for spinal and extraspinal areas for Chiropractors.  Waters get muddied when doctors do not fully understand the scope of these codes, and then bill additional services that may be bundled into the...
OOPS, this page contains content reserved for KMC University members. We’d love to welcome you to the KMC University family because there is an amazing amount of helpful content in the trainings and resources of the KMC University Library. Click here to learn more.