What Chiropractors Should Know about Billing CPT Code 97140

by | Published on Mar 17, 2023 | Medical Coding

Billing CPT Code 97140
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Chiropractors use different types of joint and spine manipulations to help ease body pain. They provide manual therapy to manipulate and massage the spine, correct structural misalignments, and reduce pain and discomfort. A chiropractic billing company can help providers bill their services correctly and get paid. Here, we are going to discuss how to bill CPT code 97140, manual therapy techniques, 1 or more regions, each 15 minutes (mobilization/manipulation, manual lymphatic drainage, manual traction). Knowing insurer rules and guidelines on the use of this code is key to avoiding denials and getting paid.

Non-compliance can lead to ignored claims, denials, and underpayments – Don’t leave money on the table!

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About Chiropractic Manual Therapy

First, let’s see what chiropractic manual therapy involves.

Musculoskeletal problems can occur due to poor posture, faulty movement habits, or injury. Chiropractic manual therapy involves the use of hands-on techniques to treat soft tissue and mobility restrictions in the extremities, neck and trunk.

CPT code 97140 covers manual therapy techniques such as soft tissue and joint mobilization, manipulation, manual lymphatic drainage, and manual traction.

  • Joint mobilization: using hands and tools to increase movement in a painful or dysfunctional joint
  • Soft tissue mobilization: using hands or tools to break up rigid muscle tissue, relieve muscle tension, decrease pain, and restore proper length and tension to muscles, tendons, ligaments, fascia and scar tissue
  • Manual lymphatic drainage: specific massage technique targeting lymphatic fluid with gentle, skin-stretching movements to to reduce swelling

Hands-on techniques applied to the joints, muscles, ligaments, tendons, fascia and lymphatic fluid can reduce soft tissue inflammation, alleviate pain, stiffness, guarding, and imbalances, increase mobility, and improves function.

Billing CPT Code 97140 – Key Points

According to the AMA, the typical patient description for direct one-on-one manual therapy services is a patient presenting “with two month history of pain in neck, shoulder, and upper back with soft tissue tightness and hypo-mobility in the cervical and upper thoracic spine”. To bill 97140 correctly, pay attention to the following:

  • First, know when to bill chiropractic manipulative treatment (CMT) plus 97140: CPT classifies spinal body regions into Cervical, Thoracic, Lumbar, Sacral and Pelvic. CPT defines extraspinal body regions as: Head, Upper extremities, Rib cage, Abdomen, and Lower extremities. Based on CPT guidelines, CMT and 97140 should be billed only when manual therapy was performed on a different anatomic region than the CMT. Manual therapy must be performed for a minimum of eight minutes.
  • Provide clear documentation. Documentation should show that both procedures were medically necessary, that is, the exam and documentation should show a subjective loss of mobility, loss of strength or joint motion, pain, soft tissue swelling, inflammation or restriction to support provision of manual therapy. Among other things, the documentation should clearly state the following:
  • Description of the specific area treated and technique used
    (i.e., manual traction, myofascial release, etc.).
  • Treatment start and end times and the total number of minutes of treatment.
  • As 97140 is a timed code, indicate the number of units administered to the patient.
  • Clinical rationale for the separate service (contraindication to CMT)
  • The documentation should also clearly state the following:
    • Diagnosis
    • Objective measurable functional limitations including objective assessment scores/summaries
    • Functional assessment
    • Clinical judgement
    • Long term measurable goals
    • Type, amount, duration and frequency of services
    • Necessity of skilled therapy of a skilled therapist through objective findings and subjective patient self-reporting

The documentation must clearly support the need for continued manual therapy treatment beyond 12-18 visits.

  • Append the appropriate modifier. When billing procedure code 97140, use -59 modifier to signify that a separate and distinct service was performed in a separate anatomic site. Modifier -59 is accepted by most payers.

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Medicare and commercial payers have their own specific rules for billing CPT code 97140 and knowing these rules is key to proper billing. A competent chiropractic medical billing company can ensure your claims are processed correctly. Experienced medical billing and coding companies have teams of coders and billing specialists who are knowledgeable about submitting claims for chiropractic services to different insurers. To prevent denials, make sure your documentation supports the use of the submitted codes.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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