Q: I am billing for manual therapy, 97140, in the lumbar spine region, while on the same visit doing chiropractic manipulation, 98940, to the cervical spine. I believe this care is payable for both codes, but I have heard I need to use diagnosis pointing.
A: You are correct that when 97140, manual therapy, is performed on the same visit as chiropractic manipulative therapy, 98940-98943, the two services must be performed to separate body regions to allow for dual reimbursement. To indicate that each service was performed in a different region, the claim form must denote the different regions through "diagnosis pointing."
It would be helpful while reading this article to have a 1500 form (formerly CMS1500 and HCFA1500) available for reference if you are not familiar with the specific blocks and lines of the form. In block 21 of the standard paper 1500 form, there are four spaces for diagnosis codes, while on electronic claims, there are eight spaces. These spaces are numbered 1-4 and 1-8, respectively, and are used to specifically designate the diagnosis that is being treated, as indicated on the billing lines of section 24 of the 1500 form. Specifically, these reference numbers are used in block 24E, in the section titled "diagnosis pointer." This pointer reference is to indicate the specific diagnosis from block 21 and indicates which diagnosis or diagnoses were treated on that specific line of service.
For example, and per your question, let's assume the following:
- Diagnosis 1 is cervical-related and diagnosis 2 is lumbar-related.
- Line 1 of the billing section in block 24 is for spinal manipulation 98940, and line 2 is for manual therapy 97140.
- On line 1 with the manipulation service, the "diagnosis pointer" in block 24E would be the number 1 to reference the manipulation service being done specifically to the cervical diagnosis (region).
- On line 2 with the manual therapy code, the "diagnosis pointer" in block 24E would be number 2, referencing manual therapy being performed to the lumbar diagnosis (region).
In doing the billing in this manner, it is clearly reported on the billing that the services meet the guidelines for reimbursement of 97140 and 98940 performed on the same visit, in that they were performed on different regions. Be certain the treatment plan and chart notes bear out the specific performance of the use of each service and that they were not done to both regions.
As a billing rule, when doing 97140 with 98940 on the same visit, the manual therapy code 97140 must be appended with modifier -59 to differentiate a distinctly separate service.
Note: The use of this modifier, -59, alone would not constitute enough information to have it reimbursed separate from chiropractic spinal manipulation. Under CMS guidelines, in order to have 97140 separately reimbursed from chiropractic spinal manipulation, the services must be done on a separate visit or different body region of the manipulation; hence the need for diagnosis pointing when done on the same visit, but to different regions.
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