What is CPT Code 97140?

CPT code 97140 is only utilized to bill manual therapy techniques, including hands-on treatment techniques intended to improve functional performance and to enhance mobility of patients with reduced pain. According to the American Medical Association, under this code, manipulations, mobilization, manual lymphatic drainage, and manual traction are covered.

Common Manual Therapy Techniques Under CPT Code 97140

Manual therapy is a hands-on treatment method whereby different techniques are used to deal with musculoskeletal problems and optimize movement, among other pain management modalities. Techniques included in CPT code 97140 include the following:

• Soft Tissue Mobilization: Techniques of manipulating muscle and connective tissue to alleviate pain and increase mobility.
• Joint Manipulation: A high-velocity, low-amplitude thrusts to increase motion in the joint.
• Myofascial Release: Techniques to release tension in the fascia to decrease pain and improve function.
• Manual Lymphatic Drainage: Gentle massage techniques stimulating the lymphatic system to reduce swelling.
• Muscle Energy Techniques: Active techniques involving a patient's voluntary muscle contraction to a controlled counterforce applied by the therapist.
• Strain-Counterstrain: Correcting abnormal neuromuscular reflexes by the positioning of the body to relieve pain.

When to Use CPT Code:

• Use CPT Code 97140 when providing any of the manual therapy techniques mentioned above, particularly when treating conditions such as restricted joint motion, musculoskeletal pain, post-surgical recovery, or lymphatic drainage needs.

Common Misconceptions:

• Manual Therapy is the Same as Massage Therapy: Manual therapy includes a broader range of techniques that go beyond what is traditionally considered massage therapy, focusing on functional improvements.
• One Code Fits All: Some therapists mistakenly believe that all manual therapy services can be billed under 97140. It’s essential to document the specific technique used and ensure it meets the criteria for 97140.

Associated Codes:

• CPT 97110: Used for therapeutic exercises focusing on strength, endurance, range of motion, and flexibility.
• CPT 97012: Used for mechanical traction therapy, often combined with manual therapy but requiring a modifier (e.g., 59) when billed together.

Time-Based Billing Explained

Billing under CPT code 97140 is time-based, being pegged on the amount of time the patient spends in therapy, thereby influencing the number of billable units. This code follows the "8-minute rule" generally imposed for Medicare, which says that there must be at least 8 minutes of therapy to bill for a single unit of 97140.

The 8-minute rule is a critical aspect of time-based CPT codes like 97140. This rule allows therapists to round up to the nearest 15-minute increment, provided that the total time spent on therapy exceeds 8 minutes in any given increment.

Example Scenarios

• 35 Minutes of Manual Therapy (97140)some text
  • 1st 15 minutes: 1 unit
  • 2nd 15 minutes: 1 unit
  • Remaining 5 minutes: No additional unit as it doesn’t meet the 8-minute threshold.
  • Total Billable Units: 2 units
• 38 Minutes of Manual Therapy (97140)some text
  • 1st 15 minutes: 1 unit
  • 2nd 15 minutes: 1 unit
  • Remaining 8 minutes: 1 unit as it meets the 8-minute threshold.
  • Total Billable Units: 3 units

Step-by-Step Guide to Using CPT Code:

Step 1: Assess the Patient

• Begin by thoroughly evaluating the patient to determine the clinical necessity for manual therapy. This involves understanding the patient’s condition, identifying areas of pain or restricted movement, and considering how manual therapy could alleviate these issues. This step is crucial for justifying the use of CPT Code 97140, as it establishes the medical necessity for the treatment.

Step 2: Document Therapy Goals

• Clearly document the goals of the manual therapy session. Specify how the therapy will improve the patient’s function, such as increasing range of motion, reducing pain, or enhancing mobility. By setting clear objectives, you create a roadmap for the therapy and provide a basis for evaluating its effectiveness.

Step 3: Describe the Manual Therapy Technique

• Detail the specific manual therapy techniques used during the session. Include information about the technique (e.g., soft-tissue mobilization, joint manipulation), the area treated (e.g., shoulder, lower back), and the rationale for choosing this approach. Precise documentation helps in communicating the treatment provided and supports the billing process.

Step 4: Record Session Timing

• Accurately record the start and end times of the manual therapy session. CPT Code 97140 is typically billed in 15-minute increments, so it’s essential to ensure that each time interval is properly documented. This ensures that the therapy is billed correctly, reflecting the time and effort invested in the patient’s care.

Step 5: Document Outcomes and Patient Response

• After the session, document the measurable outcomes of the therapy and the patient’s response. This might include improvements in range of motion, reduction in pain levels, or enhanced functional performance. By recording these outcomes, you not only validate the effectiveness of the treatment but also provide crucial information for ongoing patient care and future sessions.

Compliance Considerations:

• Medical Necessity: Always document the clinical necessity of the manual therapy to justify the use of CPT 97140.
• Modifier Usage: When billing CPT 97140 alongside other codes (e.g., 97012 for traction therapy), use modifiers (e.g., 59) to avoid claim denials.
• Accurate Documentation: Incomplete or vague documentation can lead to reimbursement issues or audits.

Key Documentation and Requirements for Billing

Successful reimbursement requires the therapist to document sessions meticulously. This includes:

• Clinical Necessity: Clearly state the medical necessity of the manual therapy techniques used, relating these back to the diagnosis and treatment goals of the patient.
• Detailed Description: Document the specific manual therapy technique (for example, joint manipulation,myofascial release) and the treated body region.
• Time Documentation: Document start and end times of the therapy session to validate total time spent.
• Outcome Measures: Include measurable outcomes about the effectiveness of therapy or progress toward goals of treatment.

Reimbursement Rates for CPT Code across Different Insurance Companies:

Maximizing Reimbursement for CPT Code 97140

Accurate billing for CPT code 97140 requires attention to detail, especially when it comes to the use of modifiers and time tracking. Here are some key considerations:

Modifier Usage

Modifiers are essential for providing additional context to the services billed under CPT code 97140. Some commonly used modifiers include:

• GP: Indicates services provided by a physical therapist.
• GO: Indicates services provided by an occupational therapist.
• 59: Used to denote distinct procedural services, especially when 97140 is billed alongside other therapy codes like 97012.

For example, when billing CPT codes 97140 and 97012 (mechanical traction) together, the 59 modifier is necessary to indicate that the services were distinct and separate.

Billing for Multiple Body Regions

If manual therapy is performed on multiple body regions during a session, each region's time should be tracked separately. The total time spent across all regions is then summed up to determine the total billable units.

Common Reimbursement Challenges

Despite thorough documentation and adherence to billing guidelines, challenges may still arise. Some common issues include:

• Incomplete Documentation: Missing details about the therapy provided, such as the specific technique or the exact time spent, can lead to denied claims.
• Improper Use of Modifiers: If multiple codes are billed and the appropriate modifiers are not used, this will result in denied claims.
• Inadequate Clinical Justification: If clear medical necessity or quantifiable and measurable outcomes have not been shown, this will result in reduced reimbursement.

Conclusion

To correctly bill for manual therapy with CPT Code 97140, you need to follow a methodical approach. This involves thoroughly assessing the patient, establishing clear therapy goals, documenting the techniques used, accurately recording session times, and tracking measurable outcomes. By doing so, you not only meet billing requirements but also improve the quality of care. Each step in this process helps justify the medical necessity of manual therapy and strengthens the therapeutic relationship with your patients. By following these guidelines, you ensure that your practice is both efficient and effective, leading to better patient outcomes and a more streamlined billing process.