97124 & & /16/2017 MASSAGE MANUAL THERAPY

Transcription

1 GO GREEN! W W W. C H I R O M I. C O M i n f c h i r o m i. c o m & M A S S AGE & M A N UA L T H E R A P Y & MANUAL THERAPY Therapeutic Procedure, One or More Areas Massage Including Effleurage, Petrissage, and/or Tapotement (Stroking, Compression, Percussion) - 15 Minute Intervals Manual Therapy Techniques, e.g., Mobilization/Manipulation, Manual Lymphatic Drainage, Manual Traction, One or More Regions - 15 Minutes Intervals - American Medical Association (AMA) CPT guidelines 1

2 Is it OK to switch codes depending on which one gets paid? Is it OK to switch codes depending on which one gets paid? The CPT manual instructs users 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. Therapeutic Procedures: A manner of effecting change through the application of a clinical skill that attempts to improve function PURPOSE OF THERAPY: Improve circulation & promote relaxation = Improve mobility in restricted areas (i.e. range of motion) = MANUAL THERAPY

3 Effleurage circular stroking movement Petrissage kneading the body Tapotement rapid & repeated striking Therapeutic Procedure, One or More Areas Massage (Including Effleurage, Petrissage, and/or Tapotement (Stroking, Compression, Percussion)) CPT code describes the work inherent in massage. Separate and distinct from Manual Therapy and CMT Massage is totally passive in nature. Massage is applied to a large area often crossing over several types of soft tissue. The expected outcomes of massage are also more general in nature and might be what the patient can tolerate at the more acute stage of their treatment plans. GOALS: increase circulation, decrease muscle soreness, and decrease muscle spasm - American Chiropractic Association Therapeutic Procedure, One or More Areas (Including Effleurage, Petrissage, and/or Tapotement (Stroking, Compression, Percussion)) & CMT Q: Is it appropriate to bill if performed in the same region as CMT? Answer: It is appropriate to perform and bill this service to the same region as CMT when clinically indicated and properly documented. Based on the definition of the CPT code 97124, there is no definitional overlap with the CMT codes and should be allowed to be billed together. 3

4 97124 & CMT Despite this, some payors still require the 59/X modifier with these services when billed on the same date and same region as CMT. Check with your payor policies & BCBSM Blue Cross Policy Regarding Delegation of Massage has been Clarified in The Record In August 2015, the MAC entered into a lawsuit settlement with Blue Cross and Blue Care Network. Coverage of medically necessary massage was included as a newly covered service in the settlement agreement. Several months after the settlement was reached, the MAC was made aware of a Blue Cross payment policy that states that massage may only be provided by MDs, DOs, PTs, and DCs, and may NOT be delegated to someone educated and trained to provide it. Our lawyers determined the policy did not violate the settlement or other laws. Blue Cross confirmed the policy in the September 2017 Record: No provider type can supervise therapeutic massage (procedure code 97124) or delegate therapeutic massage to any individual not eligible to perform therapeutic massage. As a result, only an MD, DO, PT, or DC will be eligible for reimbursement for this service. Remember, this policy does not apply to MESSA, or to some other plans that are administered by Blue Cross. Doctors are advised to have their staff check on patient coverage to be sure what is allowed under the different policies. MANUAL TH ERAP Y

5 MANUAL THERAPY Mobilization Slow, controlled stretching using deep pressure to break up fibrous muscle tissue or connective tissue adhesions Manipulation A more forceful stretching of the myofascial tissue that takes the joint just beyond its restricted barrier Manual Lymphatic Drainage A type of light massage employed to reduce swelling by gentle movement of the skin in the direction of lymphatic flow Manual Traction Controlled counterforce to induce asymptomatic strain by gently stretching muscle or connective tissue Myofascial Release Manual pressure applied to the tough membranes that wrap, connect, and support muscles Manual Therapy Techniques, (E.g., Mobilization/Manipulation, Manual Lymphatic Drainage, Manual Traction), One or More Regions May be performed on individuals with symptoms that may include: Limited range of motion Muscle spasm Pain Scar tissue or contracted tissue Inflammation or restriction GOAL Modulate pain Increase joint range of motion Reduce or eliminate soft tissue swelling, inflammation, or restriction AMA CPT Assistant & CMT Q: Why is procedure disallowed when submitted with a CMT procedure? A: An assumption of same anatomic site is made during the auditing process. The performance of manipulation includes manual traction and mobilization. There are very few indications for the application of manual therapy techniques, as described in procedure 97140, in addition to manipulation. An example of such an indication is the presence of lymphedema that cannot be treated by conventional means. This clinical situation is extremely rare. According to CPT (CPT Assistant, January 2005) regarding procedure 97140, when the therapy is applied to separate anatomic locations modifier -59 should be used to identify the performance of a distinct procedural service, unrelated to the primary procedure. Clinical code auditing logic is based on the most likely clinical situation and therefore assumes that both therapy techniques were applied to the same anatomic location. Thus, the performance of procedure with CMT represents an overlap of services and a duplication of effort that does not warrant separate reimbursement. Therefore, procedure is not recommended for separate reimbursement when submitted with procedure From BCBSM Clear Claim Connection 5

6 97140 & CMT 6 Criteria that should be documented to validate the service 1. Manipulation was not performed to the same anatomic region. 2. The clinical rationale for a separate and identified service must be documented. Example: Contraindication to CMT is present. 3. Description of the manual therapy technique(s) 4. Location (i.e., spinal region(s), shoulder, thigh, etc.) 5. Time (i.e., number of minutes spent in performing the services associated with this procedure meets the timed-therapy services requirement) 6. CPT code is appended with modifier 59/X & Q: Manual Therapy cannot be performed on the same body region as CMT codes , but does the same rule apply to Manual Therapy and the CMT code 98943? A: Yes, according to AMA CPT policy, the same rule applies. Manual therapy (97140) and all CMT codes, including cannot be performed to the same body region on the same date of service. When billing and CMT ( ) to separate body regions on the same date of service, modifier 59/X must be appended & M A S S AGE & M A N UA L T H E R A P Y 6

7 GO GREEN! W W W. C H I R O M I. C O M i n f c h i r o m i. c o m 7