Utilization Management Policy *OptumHealth Care Solutions- Physical Health includes OptumHealth Care Solutions, Inc., ACN Group IPA of New York Inc., Managed Physical Network, Inc.; and ACN Group of California, Inc.
(CPT Code 97140)Policy Original Effective Date .1/1999 Next ;.4/2013 Reporting Spinal Chiropractic Manipulative Treatment (CMT) LevelsRequirements for Utilization Review and Requirements of Timed Therapeutic > This policy has been developed to describe the criteria that OptumHealth uses to conduct retrospective utilization review (UR) of health care records, when claims have been submitted for the procedural code 97140 (Manual Therapy Techniques).Utilization Management Policy *OptumHealth Care Solutions- Physical Health includes OptumHealth Care Solutions, Inc., ACN Group IPA of New York Inc., Managed Physical Network, Inc.; and ACN Group of California, Inc.
What are the broadly adopted criteria used to describe and confirm the validated performance of CPT code 97140 (Manual Therapy Techniques)? Health care practitioners should select the CPT codes that most accurately identify the services performed Physical therapists typically report CPT code 97140 for services best described as manual therapy CMT codes (98940-98943), a form of manual treatment, are usually the most accurate CPT codes used to report manipulative treatmentThe reporting of 97140 on the same date as a CMT service requires that daily charting confirms the performance of separate and distinct services delivered to different body regions Append the modifier -59, when reporting 97140 as a separate and distinct service, during the same visit where any CMT procedural code is also recorded All in and out of network programs (exclusive of Medicare and Medicaid products for chiropractic) involving all provider types, where retrospective utilization review determinations are rendered.This policy also serves as a resource for peer-to-peer interactions in describing the position of OptumHealth on the application of CPT code 97140.
CPT Code 97140: Manual therapy techniques (e.g.mobilization, manipulation, manual lymphatic drainage, manual traction) one or more regions, each 15 minutes.Description Code 97140 is used to report manual therapy (hands-on) techniques that consist of , but are not limited to connective tissue massage, joint mobilization, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage.Manual therapy techniques may be applied to one or more regions for 15-minute intervals.
These services are not diagnosis or region specific.CPT CodingUsers of the CPT Codebook [i.e., health care providers] are instructed to, Select the name of the procedure or service that accurately identifies the service performed.
Do not select a CPT code that merely approximates the service provided. Physical and occupational therapists typically report CPT code 97140 for services best described as manual therapy techniques.[2-4] Utilization Management Policy *OptumHealth Care Solutions- Physical Health includes OptumHealth Care Solutions, Inc., ACN Group IPA of New York Inc., Managed Physical Network, Inc.; and ACN Group of California, Inc.
CPT describes chiropractic manipulative treatment (CMT) as, a form of manual treatment to influence joint and neurophysiologic function.This treatment may be accomplished using a variety of techniques.
A series of three CMT codes (98940, 98941, 98942) has been developed to describe the number of spinal regions receiving manipulation
.A single extraspinal CMT code (98943) is used by chiropractors to describe manipulative services directed at the head, extremities, rib cage, and abdomen.
Coding Modifiers: The application of coding modifiers is not a consideration when rendering UR determinations.This section is intended to provide a summary of the related OptumHealth Reimbursement policy No.0050 Modifier-59Under certain circumstances, it may be appropriate for chiropractors to report CPT code 97140 in addition to a CMT code.On these occasions it is appropriate to append the CPT procedural code 97140 with a modifier (-59).
A modifier provides the means by which the reporting health care practitioner can indicate that a CPT descriptor code (service or procedure), which has been performed, has been altered by a specific circumstance or in some way without changing the definition of the CPT code.
Modifiers increase the specificity of certain CPT codes./M00;
00; 00; /M00;
00;Modifier -59 indicates that the procedure (97140) represents a distinct service from others reported on the same date of service.This modifier was developed explicitly for the purpose of identifying services not typically performed together.Coding EditsCMS (the Centers for Medicare and Medicaid Services), the federal agency that administers the Medicare program, implemented a policy known as the Correct Coding Initiative (CCI).This policy is used to promote correct coding by physicians and to ensure that it makes appropriate payments for physician services.
This policy has been developed and applied by many third party payers across the country. /M00;
00;Correct coding emphasizes that procedures should be reported with the CPT codes that most comprehensivelydescribe the services performed e.g., 98941 is a more comprehensive code than 98940.There are procedural codes that are not to be reported together because they are mutually exclusive to each other.Mutually exclusive codes are those codes that cannot reasonably be done in the same session.An example of mutually exclusive codes germane to this policy is 97140 Manual therapy techniques (without the -59 modifier) vs.
98940, 98941, 98942,
American Medical Association;
American Chiropractic Association Chiropractic CodingSolutions The following policy statement has been developed for Blue Cross Blue Shield and has been adopted by CASD.
This section of thepolicy is reprinted with permission of Blue Cross Blue Shield Massachusetts (BCBSMA).
The complete based on the desiredphysiological response in correlation to the stages of healing.
In most conditions or injuries, utilization of onecarefully selected modality or procedure in combination with CMT is of supportive physical medicine modalities and if the same anatomical region1 as the therapeutic procedure.
If a chiropractorreports both a CPT 98940-series service and CPT 97140 on the same date of service, the chiropractors medicalrecords must document the differences between the two procedures and that each was conducted on a differentanatomical site (region).(It is CASDs policy that Billing and coding for 97140 performed on a second visit on the same day isinappropriate and not allowed when CMT has been administered in the same region as 97140.)It is not appropriate to bill CPT myofascial release, CPT 97140 should bereported.
When reporting or billing for CPT 97112 (neuromuscular reeducation) and CPT 97124 (massage), as wellas all other physical medicine modalities and therapeutic procedures, the details of the procedure shall be requiredby the selected CPT code). 1 The five spinal regions are identified in CPT as.