In 1999, the chiropractic CPT code – 97140 – was introduced. It replaced three chiropractic codes: Joint Mobilization (97260/5), Manual Traction (97122), and Myofascial Release (97250). To date, many chiropractors face difficulty in getting reimbursed for the 97140 CPT code, especially when they do a chiropractic manipulation on the same visit. Is there any way around this? Yes, there is! We stay abreast of chiropractic medical billing and coding changes and are always eager to share information regarding chiropractic CPT codes and ICD-10 codes so you get paid for your services. Read the blog to discover how to effectively utilize CPT code for 97140 and determine the appropriate circumstances for billing it.
What is the ‘97140’ Chiropractic CPT Code?
According to CPT code guidelines, 97140 CPT code is used to describe therapy that increases active pain-free range of motion, increases the extensibility of myofascial tissue, and facilitates return to functional activities. This code is reported in units of 15 minutes. This means a provider needs to provide manual therapy for a complete 15-minute. Also, note that manual therapy must be performed for a minimum of eight minutes. In April 2022, the National Correct Coding Initiative (NCCI) edits were corrected. According to the edits, chiropractors must be paid for manual therapy (97140) when performed on separate anatomic sites or at separate patient encounters on the same date of service as a chiropractic manipulative treatment (98940—98942).
When You Will Not Be Paid for the 97140 CPT Code?
CPT defines or categorizes spinal body regions into the following:
• Cervical
• Thoracic
• Lumbar
• Sacral
• Pelvic
Additionally, CPT defines or categorizes extraspinal body regions as follows:
• Head
• Upper extremities
• Rib cage
• Abdomen
• Lower extremities
97140 CPT code reimbursement depends on manual therapy (97140) and chiropractic manipulative treatment (a spinal adjustment). How? If you perform both procedures to the same region during a single office visit, your insurance payer may not reimburse you. For instance, if you are doing the CMT (98940-98942) in the lumbar region of the patient and also doing the 97140 services in the lumbar region, the payer will bundle these two services and 97140 will not be paid. But there is another scenario…
Manual therapy (97140) and a chiropractic adjustment can be performed on the same area of the patient on the same date of service. And, still, your practice can get paid for these two services. It needs to be two separate encounters. How?
For example, if a physical therapist in your clinic performed the adjunctive physiotherapy procedure and a chiropractor performed the adjustment, it would qualify as a separate patient encounter. This rule includes only licensed providers, such as chiropractors, physical therapists, and massage therapists.
97140 Chiropractic CPT Code Modifiers
Regarding the 97140 Chiropractic CPT Code modifiers, many insurance companies will “reimburse for the 97140 code” if billed with a ’59’ modifier. Use the 59 modifier (distinct procedural service) with the chiropractic CPT code 97140 when you perform manual therapy during the same encounter as a chiropractic adjustment. The 59 modifier instructs the insurance payer’s software not to “bundle” the two procedures together, preventing the denial of your payment. If the manual therapy is not completed for a complete 15-minute unit, you must report it as a reduced service by adding a second 97140 chiropractic CPT code modifier – 52. You should reduce the price for this procedure by one-half of the fee you charge for the full 15-minute session.
How to Use 97140 Chiropractic CPT Code Appropriately
How you use the 97140 chiropractic CPT code could mean a difference between getting paid and not getting reimbursed for your service. So when to bill 97140? Chiropractic manipulative treatment (CMT) and manual therapy should only be billed to insurance payers when manual therapy is performed in a body region, which is separate from CMT. For example: The patient enters your office with complaints of neck pain, middle back pain, and lower back pain. You examined the patient and found that there is segmental dysfunction in the thoracic and lumbar spine. Muscular spasms and muscular tightness are also present in the cervical paraspinal muscles. As a provider, you treat the patient with 2-level CMT (98940) in the thoracic and lumbar spine regions. You also performed manual therapy in the cervical paraspinal muscles.
Your claim should show the following codes:
• 98940
• 97140-59- 1 unit
Make sure your documentation justifies your billing and coding decisions. Your chiropractic SOAP notes will be your main source of proof that those decisions were the right ones. That means you should always:
• Include documents for why you needed to perform manual therapy
• Add treatment goals associated with manual therapy services
• Provide objective measures used to ensure the patient progresses in treatment goals
• Include progression toward treatment goals
• Indicate which regions were treated with manual therapy and with your chiropractic adjustment
• Include the treatment plan (include frequency and duration)
Understanding these aspects, including the 97140 CPT code reimbursement and the necessity of the 97140 CPT code modifier, ensures accurate billing and maximizes reimbursement for chiropractic services provided.
Conclusion
Chiropractic practices could lose revenue because of billing and coding issues. That’s why knowing what to code and when can help you get paid every time. If you want to increase the profitability of your chiropractic practice, a reliable and effective automated insurance billing system must be in place. With zHealth chiropractic software integrated with an automated insurance billing system, it is easy to maintain code accuracy, send clean claims, and create comprehensive documents. Want to know more about when to use specific chiropractic CPT codes and how zHealth chiropractic billing software can end your coding challenges? Speak to a billing expert now!
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A Complete Guide to Chiropractic Billing and Coding
