Wiki E/M with CMT

[Denise M]

Hello Everyone,

Could someone please inform on how often a Chiropractor can add and evaluation & management code (99211-99215) to CMT codes. Is it on any visit or only when there is a new concern or is there a guideline for how many days in between E/M's?

Thank you!

 

[pattiland]

The same rules apply for E/M with chiropractic as with any other specialty. The selection of an E/M code isn't based on date or days, but on patient complaint and other criteria such as new or established patient, history, medical decision making, etc. as documented by the provider. Typically in our office an E/M code is used with a new complaint, new diagnosis and longer than usual appointment.

Are you getting denials? Any more information?

 

[CodingKing]

Here's some extremely helpful information from the American Chiropractic Association on E&M with CMT

https://www.acatoday.org/LinkClick.aspx?fileticket=4fDnu2G6ss0=&portalid=60

Some additional reasons, including what Pattiland listed above. (taken from the above link)

a new patient visit, an established patient with a new condition, new injury, re-injury, aggravation, exacerbation, or a reevaluation
to determine if a change in treatment plan is necessary

Although be careful with the last one as "oh, let's just see how this is progressing" isn't going to fly. There needs to be some indicator that the current course of treatment isn't being effective and changes need to be made.

To Patti, considering CMT codes are time based, "longer than usual appointment" may be a stretch depending on the circumstances and whether the 50% spent on counseling and care coordination standard is met and documented, per the E&M DG's

 

[pattiland]

To Patti, considering CMT codes are time based, "longer than usual appointment" may be a stretch depending on the circumstances and whether the 50% spent on counseling and care coordination standard is met and documented, per the E&M DG's[/QUOTE]

Excellent point CodingKing. Thanks!

 

[ejlehman]

If you are billing E/M with a CMT code, it must be for a new condition or a recurrence with acute onset. Make sure you bill with a modifier. If more than 50% of the visit is spent in counseling, then you can bill an E/M as long as you document the time factor. The CMT code normally includes any subsequent findings, minor exams, etc.