Tips for Billing Success: E&M and manual therapy billing with chiropractic manipulations
Billing evaluation and management (E&M) codes with chiropractic manipulation treatment
Billing an established office/outpatient E&M code on the same visit as chiropractic manipulative treatment (CMT) may be inappropriate since the CMT already includes a brief pre-manipulation assessment. This common error is discussed in the coding policies of the American Chiropractic Association.
Applicable code ranges:
|99201-99205||New patients, outpatient facility|
|99211-99215||Established patients, outpatient facility|
|98940-98942||Chiropractic, manipulative treatments|
It is appropriate to bill both codes in a limited number of instances. An E&M service could be billed for the evaluation of a new patient, a new injury or re-injury, an aggravation or exacerbation, or a re-evaluation needed to determine a change in treatment plan.
An office visit may be billed on the same day as manipulation codes when the
documentation meets the E&M requirements and an appropriate modifier is used. Modifier 25 tells the payer an additional service was performed beyond the usual pre- and post-service work associated with the CMT code.
Billing manual therapy and chiropractic manipulation on the same area
Providers cannot bill for manual therapy (CPT code 97140) and manipulation treatment on the same body area on the same day. Manual therapy can only be billed with CMT if the therapy was performed on a different body area, and modifier 59 would be appended to the manual therapy code (97140) to indicate this to the payer. CPT code 97140 is also a timed therapy code, and requires time documentation to support billing.
Pinnacol conducts pre- and post-payment documentation reviews for chiropractic services. If your documentation does not support the services being billed, your request for payment could be denied or you could receive a letter requesting a refund based on an overpayment.