Wiki 59 modifier - I know nothing when it comes to billing for chiro

[soprano]

Please help. I know nothing when it comes to billing for chiro. Chart note says:

Subjective Comlaints: Sharp pain in mid back. Dull pain in neck.

Level of pain: 5/10

Objective Findings: Spinal palpation fixation:
Cervical: 3 and 5
Thoracic: 3,6,7,11, and 12
Lumbar/Sacral: Bilateral SI

Muscle Palpation - Tension/Active Trigger Points
Paraspinals

Range of Motion (N=Normal L=Limited)
C-Spine: limited
T-Spine: limited
L-Spine: limited
Sacro-iliac: limited

Assesment:
Mobility: TX well tolerated
Relief Stage: Palliative

Plan:
Chiro adjustments: 3-4 areas of the spine adjusted shown in objective findings palpation fixations.
15 minutes meuromuscular reeducation/myofascial release (direct one to one patient contact)
Paraspinals


Provider billed:
98941 (Chiropractic manipulation)
97140-59 (Manual therapy)

We received a denial for the 97140 which states " Per Medicare's Correct Coding Initiative, this CPT is a component code of 98941. We acknowledge that you are billing this service with a modifier -59. However, your notes do not support the use of modifier -59.

Is there something missing in the documentation that the provider should have written to support the 97140-59? Please advise.

 

[aaron.lucas]

Sorry to be a downer, but I dont think you can support it, because the myofascial release is directed towards the paraspinal muscles, and CMT is done on the spine, it's probably being considered as the same anatomical location, which would make the -59 inappropriate. Sorry...

 

[soprano]

Thank you so much. I will go over this with the provider.

 

[Birdie625]

97140 or 97112

Could you bill a 97112-59 instead? my concern then would be the time as it looked like the dr did both together = 15mins..I think either should be 15min increments

 

[ejlehman]

I would bill a 97112-59 instead for the therapy performed.