HealthCare News

Chiropractic Manipulative Treatment (CMT) Coding

Issue: #397 NOV2017

Topic: Coding/Billing


Claims for Chiropractic Manipulative Treatment (CMT) services must have the appropriate supportive ICD-10-CM diagnosis codes to be accepted for processing. If the CMT code is not supported by proper coding, the claim will be returned to the provider for correction.

Please refer to the current CPT® or HCPCS coding book for additional guidelines.

CPT® codes 98940-98943 are used to identify procedures related to CMT. These procedures use high-velocity, short-lever, low-amplitude thrust by hand or instrument to remove structural dysfunction in joints and muscles that may be associated with neurologic or mechanical dysfunction of the spinal joints and surrounding tissue. These procedures are specifically and primarily used by chiropractors to mobilize, adjust, manipulate, apply traction, massage, stimulate or otherwise influence the spine and paraspinal tissues to affect the patient’s health.

Chiropractors must select the appropriate CPT® code to describe the manipulative service provided during a visit. The procedure code descriptors are based on the number of body regions receiving manipulation.

Chiropractic Manipulative Treatment Codes

CPT®
98940Chiropractic manipulative treatment (CMT); spinal, one to two regions
98941Chiropractic manipulative treatment (CMT); spinal, three to four regions
98942Chiropractic manipulative treatment (CMT); spinal, five regions
98943Chiropractic manipulative treatment (CMT); extraspinal, one or more regions

Spinal Manipulative Treatment body regions include:

CervicalAll manipulations performed to the atlanto-occipital joint; C1 through C7
ThoracicAll manipulations performed to T1 through T12, including the posterior ribs (costotransverse and costovertebral junctions)
LumbarAll manipulations performed to L1 through L5
SacralAll manipulations performed to the sacrum, including the sacroccygeal junction
PelvicAll manipulations performed to the sacroiliac joint and other pelvic articulations

Note: Each CPT® code reflects a specific number of regions, regardless of how many manipulations are performed in that region.

For example:

Chiropractic manipulation applied to C3 and C5 during the same visit represent treatment to only one region (cervical) and should be reported with CPT® code 98940.

Extraspinal Manipulative Treatment

Manipulative treatment of the appendicular skeleton should be billed with CPT® code 98943 regardless of how many individual extraspinal manipulations are performed. CPT® code 98943 can be billed alone or in conjunction with a spinal CMT code.

Extraspinal Manipulative Treatment body regions include:

HeadAll manipulations performed to the head, including the TMJ, excluding the atlanto-occipital joint
Lower extremitiesAll manipulations performed to the hip, leg, knee, ankle and foot
Upper extremitiesAll manipulations performed to the shoulder, arm, elbow, wrist and hand
Rib cageAll manipulations performed to the anterior rib cage, including the costosternal junction
AbdomenAll manipulations performed to the abdominal area

Components of Chiropractic Manipulation Treatment codes

The establishment of the CMT code includes a “work per unit of time,” which is reflected in the Relative Value Units (RVUs). The RVUs take into consideration the work expense (work unit), practice expense and malpractice expense. The reimbursement amount is calculated by multiplying the RVU times the conversion factor. The conversion factor is a base dollar amount that applies to all physician codes with RVUs. Since RVUs can change from year to year, the conversion factor is recalculated annually to remain budget neutral for total physician payments.

CMT Components

Pre-serviceA brief evaluation of the patient documentation and chart review, imaging review, test interpretation and care planning
Intra-serviceTreatment applied pre-manipulation (e.g., palpation, etc.), manipulation, post-manipulation (e.g., assessment, etc.)
Post-serviceChart entry and documentation, including subjective, objective, assessment, plan consultation reporting

ICD-10-CM Coding

All CMT codes must have a supporting ICD-10-CM diagnosis code to justify the level of care provided. If the proper diagnosis code is not provided to support each CMT code, claims will be returned to the provider for correction. See below example:

For CPT® 98941, there must be at least three ICD-10-CM codes indicating the three different regions treated.

Evaluation and Management and Chiropractic Manipulative Treatment

The Chiropractic Manipulation Treatment (CMT) code includes a pre-manipulation patient-assessment component for each visit, which must be supported by appropriate documentation. Therefore, it is not appropriate to bill an Evaluation and Management (E&M) service with each CMT service. If billed inappropriately, the E&M service will be denied as provider liable.

It is appropriate to bill for CMT and E&M services if one of the following has occurred:

  • A new patient visit – defined as one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
  • An established patient – defined as one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years. The established patient must have a new condition, new injury, aggravation or exacerbation that warrants further examination above and beyond what is included in CMT services.
  • Periodic re-evaluation to determine if a change in the treatment plan is necessary.

If the patient presents for one of the above reasons that necessitates a separate and distinct clinical evaluation, the established E&M service would be appropriately reported using the modifier-25. The modifier-25 indicates that the patient’s condition requires a significant separate, identifiable E&M service above and beyond the usual pre-service and post-service work associated with the CMT service.

Manual Therapy Performed with Chiropractic Manipulation Treatment (CMT)

Manual therapy techniques (CPT® 97140) may be performed in addition to Chiropractic Manipulation Treatment (CMT) when a separate therapeutic benefit is being achieved. Some indications for utilization of manual therapy may include, but are not limited to, limited range of motion, muscle spasm, pain, scar tissue or contracted tissue and/or soft tissue swelling, inflammation or restriction, etc.

Manual therapy includes, but is not limited to, connective tissue massage, joint mobilization and manipulation, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage. The code descriptor states this is a manual, hands-on administration. (Manual therapy differs from CMT by the use of a high-velocity, short-lever, low-amplitude thrust by hand or instrument that removes structural dysfunction in the joints and muscles that may be associated with neurological or mechanical dysfunction of the joint and its surrounding tissues.)

Manual therapy, CPT® 97140, is to be reported for each 15 minutes of manual therapy technique provided to one or more regions. Manual therapy is not a mutually exclusive procedure when it is billed for different body regions separate from the CMT codes 98940-98943. Medical documentation may be requested to review appropriateness. When manual therapy is performed to the same region as the CMT with similar outcomes, it will not be reimbursed separately.

When manual therapy is billed on the same date of service as CMT and is to be reimbursed separate from
the CMT procedure, a separate diagnosis related to the treatment must be identified by a specific ICD-10-CM diagnosis code.

The following modifiers must be used when billing manual therapy with CMT codes:

  • 97140-59 – The modifier 59 is used to identify when manual therapy is being performed as a separate, distinct service with an additional therapeutic benefit that is not attained from other procedures being performed on the same date of service.
  • 97140-52 – The modifier 52 is used to identify when there is less than 15 minutes spent performing the manual therapy technique. If the amount of time spent on manual therapy techniques is greater than 8 minutes but less than 15 minutes, the modifier 52 should also be used.

Hydrobed

If using a hydrobed (aquabed, dry hydrotherapy) during chiropractic visits, it would be considered non-covered and cannot be billed interchangeably with CPT® 97022 (Application of a modality to one or more areas; whirlpool). Whirlpool treatment involves immersing the body or limb into heated water. The heated water facilitates tissue debridement, wound cleaning and/or exercise. This definition does not describe the use of a hydrobed.

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