A chiropractor recently contacted ChiroCode and told us that a payer claims that 97140 manual therapy and 97112 neuromuscular re-education are not separately billable from a chiropractic manipulative therapy (CMT), such as 98940. While Medicare's Correct Coding Initiative does require the 59 modifier to be added to these codes when billed with a CMT, nothing there prohibits them from being billed together. To clearly document that the CMT is separate from the 97140 and 97112, the record could indicate a distinct diagnosis that relates to the type of service provided. For example:
- 98940 might be justified by M99.01 segmental and somatic dysfunction, cervical region.
- 97140 might be justified by M79.1 Myalgia, myofascial pain syndrome.
- 97112 might be justified by M62.81 Muscle weakness (generalized), R42 vertigo NOS, or R26.0 ataxic gait.
The diagnosis pointers should clearly link to a distinct procedure rather than all of them. To help establish medical necessity for each procedure the care plan should outline specific and measurable goals for each service. For example:
- 98940: Show favorable changes to PART exam, such as reduced pain and increased ROM by a certain amount by a certain date.
- 97140: Reduce quantity/frequency/locations/severity of trigger points by a certain amount by a certain date.
- 97112: Improve muscle strength from 3/5 to 4/5 by a certain date. Or restore gait to normal by a certain date.
These goals are clearly separate and distinct. And they are very specific and measurable. Functional progress should then be demonstrated at each re-exam by achieving the goals, or remarking about lack of progress if applicable. If these steps are followed, reviewers should have a hard time denying a case like this.