Massage – Manual and Mechanical

ChiroCode Hot Topics, June 2007

History

There are over 80 types of massage in use today by practitioners, including but not limited to acupressure, athletic, polarity, reflexology, rolfing, shiatsu, sports, Swedish, traeger, watsu, etc.

Objective Findings

“Massage is the practice of applying pressure or vibration to the soft tissues of the body, including muscles, connective tissue, tendons, ligaments, joints...A form of therapy...massage can be applied to parts of the body or successively to the whole body, to...heal injury, relieve psychological stress, manage pain, and improve circulation.” (see http://en.wikipedia.org/wiki/Massage)

The American Medical Association (AMA) is currently the designated HIPAA authority for procedure coding. From its 2007 CPT Codebook is this description for 97124:

“Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).”

The preface and introduction to 97124 states, “Physician or therapist is required to have direct (one-on-one) patient contact.”

From its CPT Assistant, March 2006, we discover this description and expanded description for 97140:

“CPT Code 97140, Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes, was added to CPT in 1999 to accurately report manual (soft tissue and joint) techniques. Manual therapy techniques include, but are not limited to, connective tissue massage, joint mobilization and manipulation, manual lymphatic drainage, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage. As the code descriptor states “manual,” providers use their hands to administer these techniques. Therefore, code 97140 describes “hands-on” therapy techniques.”

From its CPT Assistant, August 2006 is this distinction between 97124 and 97039:

“From a CPT coding perspective, no current CPT code specifically and accurately describes mechanical massage; therefore, code 97039, Unlisted modality (specify type and time if constant attendance), would be the most appropriate code to report for mechanical massage therapy. It would not be appropriate to report code 97124, Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion).”

The Stedman’s Medical Dictionary-26th Edition definition of the “tapotement” component only was given in the 2007 ChiroCode DeskBook, “A massage movement consisting in striking with the side of the hand, usually with partly flexed fingers. syn tapping.” It does not give a comprehensive definition of massage or all massage techniques.

Assessment

From the above literature, we learn that most of the various manual therapy procedures for 97140 are performed with practitioner “hands.” The descriptor for the 97124 massage code is short and general. It is silent about all possible massage techniques for 97124, but it does include “stroking, compression, and percussion.”

Mechanical massage is not included within the 97124 code structure, and therefore the 97039 (unlisted) code should be used for it. In the healthcare industry there are various types of mechanical tables and equipment that do massage therapy. The definition of mechanical massage does not appear in CPT coding. Accordingly, the 97039 code (unlisted modality) is an appropriate expression for such massage procedures that do not require one-on-one patient contact.

When there is one-on-one patient contact which incorporates the use of any mechanical assisting device in the practitioner’s hands, the code should be 97124. The rationale would be that logic and precedent should prevail.

If this issue was presented in a typical court of law, here is the crux of the matter to consider:

  1. CPT is silent on the issue of using manual massage with mechanical assistance.
  2. CMS (Medicare) policy for chiropractic manipulative treatment (CMT) services stipulates that doctors can use an instrument (e.g Activator) in their hands to accomplish a thrust.
    Clearly and appropriately, the coding focus is on the one-on-one contact relationship between the patient and provider, and not on any massage-assisting tool or device.

Recommendations

  1. Use 97124 for one-on-one massage contact with a patient, with or without an assisting device.
  2. Use 97140 for one-on-one manual therapy contact with a patient in the above referenced cases, with or without an assisting device.
  3. Use 97039 for mechanical massage therapy (tables and equipment) that does not require one-on-one patient contact.

Alert - Because coding is dynamic, CPT information and coding could be changed in the future. Also, various payers might deviate from CPT standards and use their own different policies.

Physicians' Current Procedural Terminology (CPT) is a registered trademark of the American Medical Association

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