Coding and documenting instrument adjusting modalitiesPublished: 2010-07-20 18:45:41Author: Terry Peterson | ChiroEco | April 2010
Q: How do I code for the use of the Impulse
Adjusting Instrument?
A: There
is still a lot of confusion as to how to bill an Impulse treatment and
the answer is that it is “Manual Manipulation” billed as any other
manipulation (CMT) 98940, 98941. 98942 or 98943. The use of the Impulse
adjusting instrument does not qualify for any additional payment or use
of any other CPT code for billing.
To further
clarify, chiropractic adjustments with the Impulse family of adjusting
instruments qualify as a Medicare “covered” 98940,98941 and 98942 CMT
codes as described in CMS manual:
30.5 -
Chiropractor’s Services (Rev. 23, Issued: 10-08-04. Effective: 10-01-04,
implementation: 10-04-04) B3-2020.26 ): “In addition, in performing
manual manipulation of the spine, some chiropractors use manual devices
that are hand-held with the thrust of the force of the device being
controlled manually. While such manual manipulation may be covered,
there is no separate payment permitted for use of this device.”
Q: Can I bill for manual treatment methods in addition to spinal
manipulation? Could Impulse be billed as manual methods?
A: Doctors who want to bill the code 97140 manual methods in addition to a
spinal manipulation need to understand the limitations to its use.
First, 97140 must be used in a different area than the area of the
spinal manipulation was administered. In other words, if you were to
perform a CMT service on the cervical spine (90940, 1-2 Spinal Regions)
the only way that you could justify billing manual treatment methods
would be to perform the service at a region outside of the CMT.
Second,
the code 97140 for manual methods is a timed 15 minute code. While
there may be instances where you choose to perform a chiropractic
adjustment (CMT)
to one region of the spine, and manual methods to
another, you have to perform the manual methods procedure for a 15
minute time frame, or use a modifier to indicate the lesser time frame
for which you did administer it. Clearly, we do not advise or advocate
that chiropractors bill the use the Impulse instrument as manual
methods.
Q: Can I bill 96150
for using outcome measures in my practice?
A: Many doctors use outcome assessment measures in their practice and a
common question that arises relates to the ability to bill separately
for outcome measures such as Neck disability index, Oswestry low back
index, Rolland Morris low back index, etc. Based upon information
provided to us by primary coding experts, in the past we thought that
the 91650 code was appropriate for billing outcome assessment measures.
However it has been brought to our attention recently that there has
been confusion as to the actual intent of this code and now based upon
the most recent advice from the ACA and other legal sources, we
recommend using G8539 (as used in PQRI reporting) or E/M codes as
recommended by the ACA’s coding committee for billing outcome
assessment.
Full story