Wiki Bundling 98941 and 97112

[kasscorn]

I seem to be having an issue with some payer not allowing 98941 and 97112 to be billed together. I have appended 97112 with a 59 mod, but I am still being denied. Any suggestions?

 

[CodingKing]

What is the denial reason? Maybe its a contractual issue? I know we have some contracts that Chiro can only bill for E&Ms and chiropractic manipulation. No other modalities.

 

[kasscorn]

It's a Medicaid claim the reason code states, "Not covered when performed during the same session as a previously processed service..."

 

[CodingKing]

From what I can see in NCCI, if its performed in a spinal region undergoing CMT its not separately reportable with modified 59. If its a different region, I'd suggest appealing with notes. Although you may want to contact Medicaid first to see if they want a different modifier.

NCCI Manual text on CMT

S. Chiropractic Manipulative Treatment

Medicare covers chiropractic manipulative treatment (CMT) of five spinal regions. Physical medicine and rehabilitation services described by CPT codes 97112, 97124 and 97140 are not separately reportable when performed in a spinal region undergoing CMT. If these physical medicine and rehabilitation services are performed in a different region than CMT and the provider is eligible to report physical medicine and rehabilitation codes under the Medicare program, the provider may report CMT and the above codes using modifier 59.