cpt code 97140

CPT Code 97140 Problems & Strategies for Chiropractors to Get Paid

A few years back, I wrote about challenges that chiropractors were having with CPT Code 97140 and getting reimbursed from Aetna.   Since that time, there has been some progress, some frustrations over the lack of it and a few distinct changes that affect chiropractors getting paid for CPT Code 97140 (Manual Therapy) on the same day as their chiropractic adjustment.

Unfortunately, trouble still abounds with this code, chiropractors and their billing staff are still (sometimes) confused and audits on CPT Code 97140 have definitely increased.  So in this post, we’re going to tackle some of the most frequently asked questions and provide you with strategies to get your manual therapy work paid along with your chiropractic adjustment AND to avoid trouble (or fight back when it arrives).

Let’s start with a few basic questions we hear repeatedly:

Q: Can I get paid for CPT Code 97140 (Manual Therapy) and a Chiropractic Adjustment on the same day?

A: Yes – if you do it right!  Any payer claiming that these two procedures are not payable on the same visit is either incorrect or they have given you an inaccurate answer for errors you made.

Q: Can I perform a chiropractic adjustment in the same area as my manual therapy services?

A: No – not if you want to be paid for both.  Part of ther requirements of using the CPT Code 97140 properly when combined with a chiropractic adjustment is that the service is provide in a separate anatomical area from your adjustment.

Q: What exactly does it mean that the adjustment needs to be in a separate anatomical area from the manual therapy performed?

A: Spinal adjustments (98940-98942) are separated according to the cervical, thoracic, lumbar, pelvic and sacral regions.  Extraspinal adjustments (98943) cover the extremities. If you perform any type of manual therapy (97140), it cannot overlap with a region that you adjusted that day.  For example, if you adjust the lumbar spine, but do manual therapy work to muscles in the lumbar area,  it will not be paid.  However, if you adjust the cervical spine and do manual therapy in the lumbar, those two services are not performed in the same anatomical region, so they would be payable (if you billed and documented your service correctly).

Q: I performed the services of CPT Code 97140 (manual therapy) and I did a cervical adjustment (98940) in different areas, but my claim was still denied – what went wrong?

A:  If you performed the services in separate regions, it is also required that you “point” your diagnosis code to the regions properly on your claim form in box 24E.  This communicates to the insurance (via your claim) that you have performed the procedures according to correct coding edits.  Specifically, your diagnosis pointer (in Box 24E) for manual therapy (CPT Code 97140) cannot be the same pointer as you used for your chiropractic adjustment (989840).  This is challenging with some billing systems that automatically include all existing diagnoses in the pointer field for all services provided. If that’s the case for your billing system, you will have to manually change the diagnosis pointer so that it is correct.

Q: My claim was still denied even though I used diagnosis pointers AND provided the services in a separate anatomical region – what do I do now?

A: If you did the above correctly, I would check to make sure that CPT Code 97140 has a modifier present.  Specifically, Modifier 59 is used to indicate that the services of Manual Therapy are separate and distinct from your chiropractic adjustment – and that you want to be paid for both.

Q: We used Modifier 59 on CPT Code 97140 but we received an error message and our claim was not paid – what’s up?

A:  Medicare introduced a series of Modifier 59 “replacements” (Modifiers –XE, -XP, -XS and –XU) a few years back that were designed to be more specific than Modifier 59 and to allow you to communicate what is going on better than the traditional Modifier.  Unfortunately, private payers vary in their usage of these new modifiers. Some have adopted the new replacements (and consequently will reject Modifier 59) and some have not completely transitioned to the new modifiers.  In your case, it’s likely that you have run into a payer who has transitioned to the new modifiers, so I would submit either a corrected claim with the proper modifiers or appeal their decision so you can get paid.

Q:  I did everything you said above and my CPT Code 97140 was still rejected – what’s my problem?

A:  If your billing and coding were correct, diagnosis pointers present, services performed in separate anatomical regions, then the last issue could be your documentation. Check to make sure that your notes reflected the fact that (a) your manual therapy services were performed in a separate region in your notes; (b) you clearly indicated the regions for both CPT Code 97140 and your chiropractic adjustment; (c) that you indicated the time spent for your Manual Therapy (as it is a timed code).

Q: The payer rejected my claim, even though I did everything correctly, what do I do next?

A:  Part of the reason I wrote this post is that I know what you said is possible!  There are payers who are rejecting CPT Code 97140 when performed with a Chiropractic Adjustment for a variety of other reasons.  Here are some additional strategies for how to get paid:

  1. Appeal the Denial. In most cases, your first and best step is to appeal the payer’s denial, particularly if you have done the steps above correctly.
  2. Probe the Policy — Additionally, it is usually helpful to ask a payer for their policy regarding 97140 and the chiropractic adjustment being reimbursed on the same day in writing.  In helping with chiropractic audits over the years, I’ve found that many payers do NOT have a policy in writing.  Therefore, if you did things correctly, you have a winning appeal. On occasion, there are payers with strange policies that you never know about until you ask for their procedures in writing.
  3. Steer Around the Strange — if you are contracted and you discover a payer that, for example, simply won’t pay for 97140 and 9894x on the same day, then you have the opportunity to reconfigure your own procedures so that you can avoid trouble with that payer.  This will help save you lots of wasted time and frustration battling a payer who simply won’t pay.  And if you’re contracted with that payer whose policy is not to pay, there’s not much you can do.

 

 

 

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