Help w/ chiro notes please!!

mkmgt001

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I'm reviewing 4 DOS from a chiropractor & trying to determine if he's billing properly. I don't think he is. He's billing the same codes on each DOS: 99214, 97032, 97035 & 97140 & his notes are essentially the same for each DOS. I'm ok with CPT 97032 (E stim) & 97035 (U/S). These services are supported, but I'm questioning CPT 99214 & 97140 on each DOS. I've copied the record for 1 DOS below. Can anyone help me figure out what he's actually doing & what he should be billing? What is "adjustment assisted massage CAT II Blocking"? Shoudl this be billed as a manipulation? Help is greatly appreciated.

SUBJECTIVE FINDINGS:
The patient entered the office complaining of left neck pain and muscle spasm movement of neck causes sharp pain left low back mid dorsal pain muscle spasm any sudden movement cause sharp pain. lying down does not ease pain. pain level severe.
OBJECTIVE FINDINGS:
The examination rovealed muscle spasm, palpable area of tenderness in affected muscle corresponding trigger point. Pain reduces range of motion in the area. Visible area of muscle swelling. Myofascial T.P. and palpable bands were noted in the upper trapezius area, longlissimus and semispinaliis. Myofascial T.P. and palpable bands were noted illocostalis thoracis, iliocostalis lumborum longissimus thoracis a& gluteus.
DIAGNOSIS:
Left chronic lumbar dorsal sprain/strain with muscle splinting and limited ROM; Left
chronic cervical dorsal strain/sprain with muscle splinting.
TREATMENT:
hydrocollator, electric stimulation, ultrasound. and adjustment assisted massage CAT II
BLOCKING. right short leg cervical stair step.
PLAN: The patient should return as needed.
 

aaron.lucas

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as far as 97140, I dont think that's correct, it doesnt show any actual maniplation/mobilization, I would think if anything it should be 97124. definitely not a CMT procedure either.

the office visit I'm not sure about, definitely dont think it's a level 4, but that's just me.
 

mkmgt001

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Thank you for your thoughts on this. I agree that CPT 97140 is not supported. And after discussing this with someone that used to work in a chiro office, she felt that the chiropractor was probably performing an adjustment (98940-98943) on this visit, but he left out some commas in his note. It should probably read "hydrocollator, electric stimulation, ultrasound and adjustment, assisted massage. And she felt that he was billing 99214 for the "pre-manipulation assessment", which is included in the adjustment. The notes were very confusing. Who puts "hydrocollator" under treatment? A hydrocollator is a heating device that you store hot packs in!
 
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