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.

References: 

Coding Policy — American Chiropractic Association
Division of Workers’ Compensation Rule 18-5 (G)(5)(b)