Blog, Chirosecure Live Event September 12, 2023

How to Get Paid for Manual Therapy 97140?

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  We suggest you watch the video while reading the transcript.

Hi there everyone. It’s another episode. I’m Sam Collins, your coding and billing expert for chiropractic, ChiroSecure, HJ Ross, and of course for you thanks to ChiroSecure for this type of a program because I think this really allows you to get some information in a timely way, but also way for you to do some research.

So if you’re looking for a topic, go back and look through some of the archives. There’s a lot of information available to you, particularly for new doctors or someone getting started. Of course. Making sure you’re doing things the right way. My goal is always the coding and billing expert is to give you the right issues on coding.

Billing, reimbursement, and really just necessity of services. So today what we’re gonna do is talk a little bit about the dreaded, and I say dreaded because of reimbursements manual therapy 9 7 1 4 0. So let’s go ahead and go to the slides. Let’s talk about. What’s going on with manual therapy, and I’m gonna call this my therapy series ’cause I’m gonna do a series of these over time so that we’ll be able to have an archive of information available for you.

Manual therapy of course, is the service 9 7 1 4 0, and it’s often very confusing because, The term manual therapy. What does it mean? What is that? How do we do it? And of course, the issue that we have is whether or not it’s payable. So let’s talk about what is the manual therapy. You can see here I circled it on our list of common codes, and you’ll see here 9 7 1 4 0 says manual therapy techniques, one or more regions, which means multiple body areas.

And it says, for example, . Mobilization slash manipulation. So joint mobilization certainly fits. It says manipulation, but this wouldn’t fit for chiropractic manipulation since we have our own code for that. But it also says it includes a manual emphatic manual traction and manual emphatic drainage. Of course, it doesn’t give the full breath here ’cause this would include other things such as release.

Trigger point therapy, I would say soft tissue mobilization, but lots of things where you’re hands on treating an area that’s not just simple as massage. And so here becomes the difficulty. What is the purpose of why we’re doing it? What are the goals? But more importantly maybe is do we get paid for it?

Is it a really separate service? And here’s one of the issues we have to deal with, is how do we define it? How do we make sure, how is it different from massage? So let’s take a look. If you look at these two pictures, I’m not sure you can tell me which one is massage or manual therapy. It could be either because let’s say, what is massage massages?

The uses, it says of rhythmically applied pressure to skin and soft tissue. Everyone gets, eff, leus, petrissage, stroking and compression with the idea of muscle relaxation, circulation, and so forth. That’s a manual therapy in a way, but it’s specific that the manual therapy is a massage technique.

Now then what is manual therapy? It says manual therapy includes techniques such as soft tissue mobilization. My fascia release, I. Strain, counter strain, muscle energy techniques, joint mobilizations, manipulations by a non chiropractor md, if you will, and mobilization with movement. So if we’re doing a joint mob as opposed to manipulation, this would certainly fit.

However, I say, let’s take a look at the definition as the American Physical Therapy Association sees it, because certainly wanna see all facets and they indicate that it’s skilled hand movements and skilled passive movements. So it means the patient is involved with this as well of joints and soft tissues.

Intended to improve tissue extensibility. Increase range of motion. So I want you to think more along the lines of when you’re thinking of manual therapy. Simple massage is more the relaxation. Not to say this doesn’t do some of that. This is more so about movement extensibility. Think of a scar up muscle or joint that you’re looking to open up.

So the difference between the two is one where you’re really looking more for rehabilitation. I think, and again, I use rehabilitation broadly, but meaning one of motion or muscle length as opposed to just simple relaxation or for that matter, swelling and so forth. But here’s our problem and here’s what we’ve gotta address.

You’re all familiar with what’s called the C I edits or the correct coding initiative edits, and I’ve put them here and what they indicate now, just do a synopsis at the top it says, When you’re doing chiropractic manipulation, any services such as 9 7 1 1 2, neuromuscular education 9 7 1 2 4 massage, or 9 7 1 4 0 manual therapy are not separately reportable when performed in a spinal region undergoing C M T.

So what does that, meaning they’re saying it’s not reportable or I will say billable because they’re saying it’s inclusive. In other words, they’re indicating if you’re doing an adjustment to that region, That adjustment supersedes and would include all of those soft tissue techniques. Now, that’s slightly unfair to our profession because the osteopathic manipulation takes that in consideration and they have a higher value to their service because they included it.

I think we probably didn’t realize that when we did it, but nonetheless, they considered it inclusive. So therefore, if we’re doing it to the same area, it’s not payable. Now here’s the problem. How many of you are gonna do soft tissue work to the neck? When you’re adjusting the neck, I think a lot of us, so therefore it’s like uhoh, is that soft tissue work free?

And I’ll say because it’s just simply inclusive to the overall, so you’re not getting anything extra for it. So that means in the same region, so if I’m doing another region, so if I’m adjusting the neck and doing manual therapy to the lumbar spine, that’s fine, or to an extremity. But if I’m doing it to the neck region, they’re gonna say it’s inclusive.

So therefore when we do a separate area that is separate reportable, but we have to indicate on the claim that we’ve done that, and I’m sure you’re all familiar with, how do we do that? There’s two modifiers you can use modifier 59 or excess, and this modifier goes on manual therapy. So when you’re billing manipulation, With it, having a manual therapy technique of any type, you have to put modifier 59.

And what is that indicating to the insurance? That it was performed to a separate region. Now, 59 is a little less specific. It just says it may be necessary to indicate a procedure. Service was distinct, where excess gets a little bit more, that it was a separate organ or structure. Technically, the XSS is better.

Because it indicates more the separate region, frankly, in many ways it doesn’t matter so long as you have one or the other. Two indicate separate. But the big issue is did you do it to a separate region? It’s not so much, it’s a separate service, but it has to be a separate region. That’s what the 59 or excess means.

So that means in order for it to be payable, here’s what’s difficult. You have to show number one, manipulation was not done to the same anatomic region. Number two, that there’s a separate rationale. For the soft tissue compared to the adjustment, you have to describe it. And if you just said massage, I think you can get away with that.

But manual therapy, what we’re talking about, it’s a little bit different. Manual therapy can encompass a lot of things. So you do need some specificity there to say, did I do manual traction? Did I do myofascial release mobilization, muscle energy. So realize you have to describe more than just saying manual therapy.

’cause it could mean a lot of things. Then of course, tell me where you did it. Then of course, the minutes and remember, 15 minute code, eight minute rule will apply and then of course, ultimately billing it with modifier 59. So if you’re doing a separate area, no problem. How do you do that? You make sure to do a separate area.

Now I wanna show you something though. This is from Optum Health and UnitedHealthcare and being adopted by many more. The one thing they’re indicating that’s different, it says spinal C M T codes with manual therapy provided to a different non-contiguous body region. So if you think of it, if you’re doing cervical and then doing manual therapy, thoracic is the thoracic spine contiguous to cervical?

It is. So they told it even a little bit stricter. So be conscientious that you really want a complete separate area. Now, I will say Optum pushes this hard, but realize that other carriers may be doing the same. They go even further. And it’s down here in red. Notice it says, manual therapy techniques may not be billed to the same data services, extra spinal code when the manual therapy service is provided to any extra spinal region being the way the codes are described.

When you say extra spinal, it includes anywhere. So unfortunately what this means is if you’re doing the adjustment to the knee and doing the manual therapy to the shoulder, they’re gonna consider that the same region. ’cause extra spinal is one region. That to me, is a little picky, but I. What I’ve heard mostly is that really doesn’t come up much.

It’s usually, obviously if you’re doing a spinal adjustment in an extra spinal area for manual therapy, you’re okay. So how do we do this? On the claim form, this is what it should look like. Take a, notice that diagnosis, A and B or cervical radiculopathy and myalgia of the neck diagnosis C and D are back pain with arthritic changes.

So notice 9, 8, 9, 4 oh points that the adjustment is occurring to the a and B region, meaning. Cervical 9 7 1 2 4. In our case, we’re talking about manual therapy. We put 59 or excess and then indicates C and D. What are we indicating here That the massage or manual therapy went to the lower back?

Completely separate areas that would be payable. So before you start disputing, make sure, am I doing it right? When you send a claim, can someone see it’s a separate area? ’cause a lot of us, when you bill a claim out, when you put for diagnosis, what happens? This just puts a, B, C, D. So what are you telling them?

I did all the regions. You’ve gotta be very specific to keep the region separate. That’s what makes Thiss code so hard. Now, I will tell you, I’ve been around chiropractic my entire life and there was no such thing as manual therapy massage until the middle eighties when we came out, if you remember the Myofascia release code.

And of course that became very prominent. A lot of doctors used it. We’ve done it so much that they started to indicate that it’s just done every single time. So I’m gonna go back to wondering . When we do manual therapy, and I’m not an anti-man therapy person, but I’m anti not getting paid. If you’re gonna do a 30 minute manual therapy to the same region, you’re adjusting, do understand that manual therapy is included.

There’s no extra payment for that 30 minutes. What if you’re paying a staff to do it? So I want you to think of, there’s nothing wrong with manual therapy. Maybe I do it on a separate visit, I don’t know. Or what is the real purpose of care? What are you attempting to do with manual therapy? What is the goal?

If that goal is rehabilitation, maybe why not focus on active rehabilitation? Think of passive versus active care, passive care. The initiation, again, a lot of times with the muscles so locked up, you’re gonna do manual therapy ’cause maybe you can’t manipulate. Then once it’s open enough, maybe you manipulate.

But think of it, passive care is that early stage. What about active care? You’re all familiar with all of the guidelines that indicate people need more active care. True rehabilitation. And of course manual therapy is part of that, what’s the best way to rehabilitate something? Strengthen. If you think about what do physical therapists do?

Mostly exercise. So I would think, take a look at if you’re emphasizing manual therapy and having a hard time being paid, are we barking up the wrong tree for the outcome of the patient and maybe doing a little bit more of active care. Remember, active care is gonna be things like exercise. , or for that matter, therapeutic activities, realize there’s no separate region that’s needed.

You can do them the same. The R V U is higher. It’s worth more money, if you will, and multiple units aren’t unusual. Would it be unreasonable to think a person needs a 30 minute rehab? Have you ever had anyone go, man, I’ve been going to the gym and I go 10 minutes or even 15, and boy am I much better? No, I would say most people take at least 30.

So I would suggest would two units of exercise be reasonable for many patients without the whole extra region, with a much easier way to demonstrate the necessity and the outcome. Again, I won’t be anti-man therapy, but my concern is I get so many providers coming to me, Hey Sam, how do I fix this? I can’t fix if you didn’t do a separate region, or if it’s with United, it’s non-contiguous.

So keep in mind when you look at this, look at the overall outcome of the patient. And whether or not you’re being reimbursed, it is the value there. I have one doctor that goes, Sam, I’ve cut my manual therapy down to a couple of minutes ’cause it does what I need. I get to the adjustment, I focus more on active care and he goes, man, I’m getting paid better.

Something to think of. Again, if you’re doing different regions, modifier 59 or excess, that’ll get paid. But be careful if someone audits you and you said you did a separate area and it’s not demonstrated that you did. That’s on us. So be conscientious. I’m here to help. The HJ Ross network is your resource.

We do seminars, but we also do one-on-one. You want someone to really help you. Let me be your expert. I become part of your staff. Join our network. Until next time, friends, I’ll see you in. .