Manual medicine cpt code

You can append either the modifier or the X modifiers; both are accepted forms of billing at this time. But what about the reference to the noncontiguous body region? The policy says:. The spinal regions are cervical, thoracic, lumbar, sacral, and pelvic. The extraspinal regions are head; lower extremities; upper extremities; rib cage. Notice how Optum pulls it all together.

First, Optum clarifies contiguous and noncontiguous body regions as follows:. The treatment of myofascial structures using manual therapy techniques in the same organ, where CMT was performed and was not contiguous cervical and lumbar , forms treatment of different anatomic sites. The treatment of the cervical spine and a shoulder joint does constitute treatment of different anatomic sites.

Most payers publish their Medical Review Policy MRP for such things, and providers who bill the payer should take heed of the rules of the game. These are essential factors to review before billing these services, ensuring that the clinical record matches the CPT codes billed:. If you are billing with , you may notice it is tough to satisfy all of the criteria listed above.

In addition to documentation, ensure your billing is consistent with the reason for performing by pointing to the correct diagnosis code. The reason for performing CMT should never be the same as when billing. If you regularly perform both CMT and , make sure you consider the coding guidelines provided by the payers with whom you deal. In addition, look for MRP that describes their rules for billing both services and what they expect in the documentation.

Per CPT guidelines, is about manual therapy techniques, like mobilization and manipulation, manual lymphatic drainage, and manual traction. In addition, chiropractic adjustments have their codes , or for an extremity. Therefore, if you report a subluxation diagnosis code, you should perform an adjustment.

National Correct Coding Initiative NCCI requires to edit bundle manual therapy to chiropractic adjustment codes when performed in the same anatomic region. Example 1: The chiropractor makes chiropractic adjustment Chiropractic manipulative treatment CMT on the cervical region. He then performs manual therapy to the same cervical region. Therefore, the manual therapy would not be reimbursable in this scenario.

Example 2: The chiropractor conducts chiropractic adjustment Chiropractic manipulative treatment CMT on the cervical and lumbar regions. The diagnosis pointers connect the manual therapy to the diagnosis codes adhering to capsulitis In this situation, the manual therapy would be separately reimbursable if reported with modifier 59 added.

Pulses PRO. Medical billing Training. Thursday, January 13, Sign in. Forgot your password? Get help. Password recovery. Medical Coding. By Dennis L. October 25, Must read. January 4, The following description form more detail about manual therapy: Manual therapy is used actively and passively to help effect changes in the soft tissues, articular structures, and neural or vascular systems.

The service expects to increase pain-free range of motion and aid a return to functional activities. An example is the restoration of movement in sharply edematous muscles or stretching of shortened connective tissue. Manual therapy is used when a loss of motor ability impedes function. The early years of the code The old code -Myofascial Release, which many providers used for trigger-point therapy, was billed along with the CMT code for any muscle work performed in combination with the adjustment.

Category III codes are temporary codes that represent new technologies, services, and procedures. Temporary codes describing new services and procedures can remain in Category III for up to five years. If the services and procedures they represent meet Category I criteria — which includes FDA approval, evidence that many providers perform the procedures, and evidence that the procedures have proven effective — they will be reassigned Category I codes.

Conversely, Category III codes can be eliminated if providers do not use them. First, as you might imagine, procedural coding necessitates a solid grasp of anatomy and medical terminology.

One procedure might have numerous variations, differing only slightly, and selecting the right code will require an ability to comprehend the clinical documentation and code description — to understand what a given procedure is, how the physician performed it, and which code descriptor captures the highest specificity of the procedure performed.

The codes a provider can report are not limited by the specialty in which they practice. For example, X-ray codes are listed under radiology, but a primary care coder will be required to assign an appropriate X-ray code if the primary care physician interprets an X-ray. This is the best way to ensure coding accuracy and optimal reimbursement for your employer. A modifier consists of two numbers, two letters, or a number and a letter. For example, some modifiers show that a procedure was performed on the right side of the body, versus the left side or both sides.

Other modifiers indicate that a physician took extra time and effort to perform a service or procedure. A short list of modifiers goes a long way in expanding the ability to report the unique circumstances of services and procedures performed. Examples of services, supplies, and items with HCPCS Level II codes include orthotic and prosthetic procedures, hearing and vision services, ambulance services, medical and surgical supplies, drugs, nutrition therapy, and durable medical equipment.

An example of a diagnosis and service meeting medical necessity is when a patient comes into a medical office complaining of stomach pain, and the physician conducts a physical examination. Manual therapy techniques are used to treat the restricted motion of soft tissues in the extremities, neck, and trunk. The following descriptors outline more detail about manual therapy:. Chiropractic adjustments have their own set of codes , or for an extremity.

If you report a subluxation diagnosis code, you must perform an adjustment. If the claim is properly filed and supported by documentation, the insurer should pay for both procedures.