97140 CPT Code: Know Your CPT Codes

Introduction

Understanding medical billing codes can be tricky, especially for specialized services like manual therapy. 97140 is one such code that often raises questions for healthcare providers and patients. This article discusses the 97140 CPT code for manual therapy, clarifying its uses, billing rules, and key differences from other modalities like massage.

What is 97140 CPT Code?

CPT code 97140 describes manual therapy techniques, including mobilization, manipulation, lymphatic drainage, and traction, performed on one or more regions of the body. These hands-on techniques aim to address restricted movement in soft tissues, improving pain-free range of motion and promoting functional activities. Manual therapy is used to address conditions like:

• Limited joint motion: Stiff neck, frozen shoulder, or restricted ankle movement? Manual therapy can help regain lost range, reducing pain and improving daily activities.
• Muscle weakness or imbalance: Muscles not pulling their weight? Manual techniques can activate weak muscles and rebalance muscle groups, leading to better posture and movement patterns.
• Soft tissue adhesions: Scar tissue or ‘knots’ in muscles can restrict movement and cause pain. Manual therapy can break up these adhesions, promoting tissue healing and smoother movement.

Billing Rules and NCCI Edits

To ensure proper reimbursement, understanding billing rules and NCCI edits is crucial. Here’s the lowdown:

• Time-based code: 97140 is billed for each 15-minute increment of direct patient contact with manual therapy techniques.
• NCCI bundling: Be mindful of NCCI edit group CG-0520. They get bundled under the adjustment code if you perform manual therapy and a chiropractic adjustment in the same region. To bill separately, either treat different regions or append modifier 59 to the adjustment code, ensuring your documentation clearly justifies separate services.
• Medicare Coverage: Medicare generally covers manual therapy when medically necessary and performed by qualified providers. However, specific coverage details can vary depending on the patient’s plan and diagnosis.

Documentation is Key!

Comprehensive documentation is your best friend when it comes to accurate coding and avoiding claim denials. Make sure your notes include:

• Indications for treatment: Clearly explain why the patient needs manual therapy.
• Specific techniques used: Describe the manual techniques employed and their rationale.
• Treatment duration: Document the total time spent on manual therapy in each 15-minute increment.
• Patient response and progress: Track the patient’s response to treatment and their progress towards stated goals.

Differentiating Manual Therapy from Massage

Don’t confuse manual therapy with massage! While both involve hands-on techniques, their goals differ:

• Manual therapy: Focuses on improving joint mobility, muscle function, and pain relief for specific conditions. Think ‘targeted therapy.’
• Massage: Primarily aims at relaxation, stress reduction, and general well-being. Think ‘spa day.’

Additional Tips for Accurate Billing

• Use modifier 25: If significant additional time is spent on manual therapy beyond the 15-minute unit, consider using modifier 25 to indicate prolonged service.
• Modifier XE for exceptional circumstances: In rare cases, if manual therapy requires significantly more time and resources due to exceptional circumstances, modifier XE can be used to request additional payment.
• Stay updated: Billing regulations and code descriptions can change over time. Regularly check resources like the American Physical Therapy Association website for updates.

By understanding the details of the 97140 CPT code and maintaining accurate documentation, you can ensure proper billing for your manual therapy services and help patients access the care they need to regain function and improve their quality of life.

While mastering 97140 empowers your practice, navigating complex coding can be time-consuming. For expert assistance, consider partnering with PrimeCare. Our experienced team can help ensure accurate coding, optimize your claims, and minimize denials, allowing you to focus on quality patient care. Contact PrimeCare today and let us handle the billing, so you can focus on what matters most – your patients.

References:

• Medicare Managed Care Manual Chapter 11
• American Physical Therapy Association (APTA) group therapy resources

The American Medical Association (AMA) owns the copyright for the Current Procedural Terminology (CPT) coding system. It’s important to note that CPT codes can vary over time and may be subject to updates and revisions. The AMA periodically releases new editions of the CPT code set to reflect changes in medical practices and technology, as well as updates in reimbursement guidelines.