Wiki Help with chiropractor billing

[Rhonda Stroup]

Hi, doing an online course, and need some help with chiropractor billing! Can they bill a 98940 along with a 97140.? Do they need to be done on separate body parts? Separate providers, for ex. the chiro does the adjustment (98940) and the PT does the 97140? Thanks!

 

[pammalou]

If you are billing under same tax id, from my experience you would not be able to bill the chiropractic manipulation 98940, 98941 or 98943 on the same date as a 97140 even if you append with a -59. This goes for if you are billing under DC for manip and PT for manual therapies as well. It will be denied.

 

[ralmero]

According to NCCI, CPT 97140 and 98940 can be performed on the same area when delivered during "separate encounters" with the same patient. Two definitions have been provided: 1) Different providers perform the two procedures on the same date of service. For example, if a PT performed the adjunctive physiotherapy procedure and a chiropractor performed the adjustment, it would qualify as a separate patient encounter. This rule includes ONLY licensed providers, such as chiropractors, physical therapists and does not include chiropractic assistants; 2) The same provider performed the two procedures during a second visit on the same date of service. In this case the patient would receive his or her chiropractic adjustment during a visit in the morning, and physical therapy at a second encounter later in the day.

When billing, you must add modifier 59 (distinct procedural service) to CPT 97140 if it was performed on the same day as CPT 98940. Documentation must also support that the procedures were made during separate encounters. Failure to append the modifier 59 AND provide documentation might result to payment denial.

 

[gmrossi]

You can bill both 98940 with 97140 with -59 modifier according to the CCI Edits. HOWEVER, recently Aetna is denying 97140 as inclusive and I was told that they will start to implement this denial as VALID in 2013. WHICH edits are they using??? This isn't fair... they can't just make rules up as they go along~

 

[mitchellde]

According to NCCI, CPT 97140 and 98940 can be performed on the same area when delivered during "separate encounters" with the same patient. Two definitions have been provided: 1) Different providers perform the two procedures on the same date of service. For example, if a PT performed the adjunctive physiotherapy procedure and a chiropractor performed the adjustment, it would qualify as a separate patient encounter. This rule includes ONLY licensed providers, such as chiropractors, physical therapists and does not include chiropractic assistants; 2) The same provider performed the two procedures during a second visit on the same date of service. In this case the patient would receive his or her chiropractic adjustment during a visit in the morning, and physical therapy at a second encounter later in the day.

When billing, you must add modifier 59 (distinct procedural service) to CPT 97140 if it was performed on the same day as CPT 98940. Documentation must also support that the procedures were made during separate encounters. Failure to append the modifier 59 AND provide documentation might result to payment denial.

If the PT and the physician practice in the same office then this is not considered different providers. if there is one performed in the AM and one in the afternnoon you will need to show a medically necessary reason for this.