Q: It seems that our office is having a difficult time being reimbursed for manual therapy (97140) when we do a chiropractic manipulation on the same visit, even with the modifier -59.
A: Well, the key is not how to "get around it," but to learn how to use this code properly to be paid. Insurance companies must reimburse for 97140 services when they are performed on a separate encounter or to a differing region of the CMT. This means if you are doing the CMT in the cervical region and also doing the 97140 service in the cervical region, they will be bundled and 97140 will not be paid. If you only have one region of diagnosis and wish to be paid for the CMT and 97140, the patient would need to return for a separate visit for the 97140 service. Conversely, to be paid for both services on the same visit, you would need another region of diagnosis such as lumbar spine. In that region, you would need to perform the 97140 service - but not a CMT.
I understand this may be perplexing to most chiropractors; doing services coded with 97140 such as myofascial release, joint mobilization, and manual traction certainly require separate performance from a chiropractic adjustment. Unfortunately, even with this consideration, according to the Correct Coding Initiative Edits (a document published under Centers for Medicare and Medicaid Services that determines which codes should and should not be billed for or paid when done together), 97140 when done in conjunction with chiropractic manipulation to the same region is not to be reimbursed separately This actually has been in effect since 1999, when the 97140 code was introduced.
But interestingly, many insurance companies will pay for 97140 as long as it is billed with a -59 modifier. The modifier -59 indicates a distinct procedural service and using this distinction satisfies many insurance payers that the services were separate. However, several insurers have taken the hard line and will not pay for 97140 unless it is done to a separate region. Therefore, if doing both services to the same region, you must do them on a separate visit or those carriers will not pay for the 97140 service. It may be worthwhile to write a letter indicating the separate nature of each service in its performance and outcomes, but this is no guarantee that they will allow it. The submission of treatment notes, specifically the treatment plan, would be helpful to distinguish the services. To document the separate nature, clearly identify the specific services performed. For mysofascial release, for instance, notes should highlight the specific soft tissues addressed, type of technique/style, time spent, patient interaction, and outcome. This would clearly show that the procedure is distinct from a chiropractic spinal manipulation.
If you do have two separate regions of diagnosis, you simply would need to apply proper diagnosis to show which service was applied to which area. For example, if diagnosis #1 in block 21 of the CMS 1500 form is cervical spine, and diagnosis #2 is lumbar spine, then in block 24, on the billing line with the CMT code, the #1 would be placed in section 24E to indicate that the service was for diagnosis #1 cervical spine. On line 2 of section 24, it would have 97140-59, and you would place #2 in 24E, to indicate this service was for diagnosis #2 lumbar spine. By doing the billing in this manner, you have demonstrated without any additional documentation that the services were to different regions.
Finally, do not use another code if you are doing a service that is coded under 97140. You may not bill a service under another code simply for reimbursement purposes. If you are doing a service that is not under 97140, then of course, the code for that service should be used.
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