FYI - I am not a coder (cert. in medical billing). I have no idea what they are talking about.
This is what I found on HAPs website - clear claim connection:
Click on recommendation of "Disallow" or "Review" to obtain clinical edit clarification.
Line Procedure Description Mod 1 Mod 2 Quantity Date of Service Place of Service Payment RVU Pay % Recommend
1 97140 MANUAL THERAPY 1.00 8/1/2011 11 (Office) n/a 0 Allow
2 97124 MASSAGE THERAPY 59 1.00 8/1/2011 11 (Office) n/a 0 Disallow
3 97530 THERAPEUTIC ACTIVITIES 59 1.00 8/1/2011 11 (Office) n/a 0 Allow
4 97113 AQUATIC THERAPY/EXERCISES 59 1.00 8/1/2011 11 (Office) n/a 0 Allow
Per HAP - 97124 is included w/ 97140
Inquiry:
Why is this procedure disallowed?
Procedure Description
97124 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT (STROKING, COMPRESSION, PERCUSSION)
97140 MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), 1 OR MORE REGIONS, EACH 15 MINUTES
Response:
HCPCS/CPT codes define procedures include services that are integral. Integral services have CPT codes for reporting service when not performed as an integral part of another procedure. Services integral to HCPCS/CPT code are procedures included in services based on standards of medical/surgical practice. It is inappropriate to report services alone that are integral to another procedure.NCCI edits are based on standards of medical/surgical practice. Services that are integral to another become component parts of comprehensive service. Integral component services have their own HCPCS/CPT codes, NCCI edits place comprehensive service in column one and component service in column two. A component service integral to comprehensive service is not separately reportable; column two codes can not be reported separately with column one code.Services are integral to large numbers of procedures. Other services are integral to a limited number of procedures. Examples of large number of procedures include:" Cleansing, shaving and prepping of skin" Draping and positioning" Insertion of intravenous access for medication administration" Insertion of urinary catheter" Sedative administration by physician performing procedure (Chapter II, Anesthesia Services)" Local, topical or regional anesthesia administered by physician performing procedure" Surgical approach including identification of anatomical landmarks, incision, evaluation of surgical field, debridement of traumatized tissue, lysis of adhesions, isolation of structures limiting access to surgical field such as bone, blood vessels, nerve, muscles including stimulation for identification or monitoring" Surgical cultures" Wound irrigation" Insertion/removal of drains, suction devices, pumps into same site" Surgical closure and dressings" Application, management, and removal of postoperative dressings and analgesic devices (peri-incisional" TENS unit" Institution of Patient Controlled Anesthesia" Preoperative, intraoperative and postoperative documentation, including photographs, drawings, dictation, or transcription necessary to document services provided" Surgical supplies, for specific situations where CMS policy permits separate paymentChapters in Manual address issues related to standards of medical/surgical practice for procedures covered. It is not possible because of space limitations to discuss all NCCI edits based on principle of standards of medical/surgical practice. There are general principles that can be applied to edits as follows:" Component service is accepted standard of care when performing comprehensive service." Component service usually necessary to complete comprehensive service." Component service is not separate procedure when performed with comprehensive service.
Therefore, this procedure is not recommended for separate reimbursement.
Now this is what I found on BC's web site clear claim connection:
Claim Audit Results
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Gender: Date of Birth:
Recommend Procedure Date of Service Description Modifiers
Allow 97113 08/09/2011 AQUATIC THERAPY/EXERCISES GP
Allow 97530 08/09/2011 THERAPEUTIC ACTIVITIES GP
Allow 97140 08/09/2011 MANUAL THERAPY GP
Allow 97124 08/09/2011 MASSAGE THERAPY GP
The results displayed do not guarantee how the claim will be processed.
Now this info I got off of Ingenix Encoder:
CCI Mutually Exclusive
Warning: These codes may not be billed together. Check to see if a modifier is allowed and supported by documentation.
Code Description Fee FA_Total Fee Work RVU PE RVU FA_PE RVU MP RVU Total RVU FA_Total RVU Fee Type Modifier Primary or Secondary
97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes $27.86 $27.86 0.43 0.38 0.38 0.01 0.82 0.82 Non Facility Allowed N/A
97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes $32.28 $32.28 0.44 0.5 0.5 0.01 0.95 0.95 Non Facility Allowed N/A
Code Description Fee FA_Total Fee Work RVU PE RVU FA_PE RVU MP RVU Total RVU FA_Total RVU Fee Type Modifier Primary or Secondary
97530 Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance), each 15 minutes $32.28 $32.28 0.44 0.5 0.5 0.01 0.95 0.95 Non Facility Allowed N/A
97140 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes $27.86 $27.86 0.43 0.38 0.38 0.01 0.82 0.82 Non Facility Allowed N/A
It looks like they are payable w/ modifiers. I would try mod 59 on all but 97140
