HNS Policy 

 

Added 5/1/2019

 

The AMA CPT (Current Procedural Terminology) 2019 edition describes 97140 as "Manual therapy techniques (eg. mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes".

 

Manual therapy is classified as a Therapeutic Procedure (time-based).  A Therapeutic Procedure is defined as "a manner of effecting change through the application of clinical skills and/or services that attempt to improve function".

 

Therapeutic procedures require direct one-on-one patient contact by a physician or therapist and can only be performed by the physician or an appropriately licensed therapist.

 

Manual therapy
should not be billed
on the same region as manipulation.

 

Manual therapy should be used the same day as a manipulation ONLY in certain circumstances, and the rationale must be clearly documented.

 

The ACA Chiropractic Coding Solutions Manual gives the following example of the appropriate use of 97140 on the same day of a manipulation:

 

"A patient has severe injuries from an auto accident with a neck injury that contraindicates CMT in the neck region.  Therefore, the provider performs MANUAL THERAPY to the neck region and CMT to the lumbar region.  In this instance, it would be appropriate to report both the 97140 and the CMT."

 

If it is appropriate to report 97140 (manual therapy) together with a CMT, the manual therapy code (97140) must be appended with the modifier -59 to indicate a "distinct procedural service".

 

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ACA Coding Policy:
Position on the Proper Use of Procedure Code 97140

 

Time-Based:

All time-based therapies (both therapeutic procedures and constant attendance) are billed in 15-minute increments.

 

If provided for less than 8 minutes, the service should not be billed to the payor.

 

It is important to recognize that 15 minutes must be spent in performing the pre-, intra-, and post-service work in order to report code 97140.  Common components included as part of Therapeutic Procedures include chart reviews for treatment, setup of activities and the equipment area, and review of previous documentation as needed.

 

Medical Necessity:

When performed and billed to a payor, modalities/therapies must be medically necessary, consistent with the patient's chief complaint/clinical findings, diagnoses and treatment plan.

 

Documentation:

When performed and billed to a payor, modalities/therapies must be properly documented in the healthcare record.  Documentation must include the rationale for each therapy and must clearly establish the medical necessity for each therapy billed to the payor.

 

For ALL modalities and therapies, documentation must include: 

 

•   Type of modality

•   Rationale

•   Area of application (specific region treated)

•   Setting and frequency (as applicable)

•   If time based code, actual time service performed

 

Reminders:

All therapies/modalities must be accurately reported using the most appropriate CPT or HCPCS Code.

 

During the initial phase of care, no more than two therapies or modalities per visit are considered usual and customary.

 

There should be a reduction in the use of therapies as the patient's condition improves.