Wiki 98941 & 97140

[leasiepops]

Hi,

I have a patient that has the following DX: M54.2, S33.5XXA, M25.519 (bilateral shoulder), and S23.3XXA. I have enough regions to bill a 98941 but can I also bill 97140-59 since there is an extremity in the DX? Or, do I have to bill 98940 & 98943 to be able to bill the 97140-59?

Any help with this question would be appreciated!

Thank you!
Leah.

 

[pattiland]

unlikely to get paid?

In our office, 97140 is usually bundled with the spinal manipulation by our payers. It can be paid when performed alone, or when appealed with documentation. Our provider doesn't do it very often or he combines it with a manipulation. Here's what AAPC says:

National Correct Coding Initiative (NCCI) claim edits bundle manual therapy (97140) to chiropractic adjustment codes (98940-98942) when performed in the same anatomic region. If the procedures are performed in separate anatomic regions, you may report them separately by appending modifier 59 to the adjustment code (97410 is the “column 2” procedure). If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.

You wouldn't bill the 98943 unless the provider manipulated the shoulder. If she manipulated the shoulder and also performed manual therapy at the same site, most payers will only cover the 98943.

I'm curious if anyone else has a different experience?

 

[leasiepops]

Thanks

Thank you for the clarification.

Leah.