Chiropractic Billing and Physical Therapy

THE GRATUITOUS DISCLAIMERmovement, balance, coordination, kinesthetic
This article is not intended as a replacement forsense, posture, and/or proprioception for sitting
authorized chiropractic billing educational programs.and/or standing activities, one or more areas. This
The author is a Medical Biller and speaks mostlycode is intended to identify neuromuscular
from practical experience as opposed tore-education, designed to re-educate the muscle
organized theory-based resources and materials.for some function it was previously able to do
Certainly it is up to the reader to research the(not intended to identify massage to increase
topics discussed with their individual insurancecirculation, etc). This will usually be in the form of
carriers.some commonly performed task for that body
ARE YOU LEAVING MONEY ON THE TABLE?part. 15 minute units. (Examples: feldenkreis,
Most chiropractors add physiotherapy to theirbobath, bap's boards, desensitization techniques...)
study courses while training for Chiropractic.Sometimes you will be asked for notes proving
Regular Physiotherapy. Unfortunately, manymedical necessity if you use this code., so be sure
chiropractors do not take advantage of theirit is medically necessary!
Physiology licenses and therefore leave money on97140: One-on-one. Manual therapy techniques -
the table as far as insurance billing is concerned!myofacial release, mobilization/manipulation, manual
Although some insurance plans will not coverlymphatic drainage, manual traction, trigger point -
Physical Therapy performed in the chiropractor'sone or more regions, 15 minute units, charges can
office (such as Medicare), there are plenty thatbe up to $50.00 per unit, and a good average is
do. If you find yourself too busy to performfrom 1 to 3 units.
therapy for your patient, hire a CA certified in97140 is used to describe therapy which increases
Physiotherapy to handle the Physical Therapy partactive pain-free range of motion, increased
of their treatment.extensibility of myofascial tissue and facilitates
More insurance money for you, but WHO ELSEreturn to functional activities. This code is
BENEFITS?reported in units of 15 minutes. It would include
Your patient benefits also from PT beingneuromuscular therapy, positional release,
performed in your office. It will facilitate theirstretching and nearly any therapeutic technique
healing process, and if they complete their atperformed manually for the purposes mentioned
home exercises, your patients will be less likely toabove. This therapy is to be performed on an
re-injure themselves. So if you are not performingarea separate and apart from the area of main
PT for and on your patients, you are doingcomplaint in order to successfully bill to insurance.
yourself and them a disservice.Append the 59 modifier to this code.
Check your PT coverage97124: One-on-one Massage, including effleurage,
When you, your staff or your billing service verifypetrissage and/or stroking, compression,
Chiropractic Insurance benefits, be sure topercussion, one or more areas, each 15 minutes
specifically ask for Physical Therapy benefits. AskThe main difference between 97124 and 97140 is
if Physical Therapy can be performed by athe intention of the therapy.
Chiropractor. If so, then ask if there is a separateIf the therapist is performing therapeutic massage
deducible. Normally there is not, but you want toin order to increase circulation and promote tissue
be sure. If you are contracted with the insurancerelaxation to the muscles, then use code 97124. If
carrier, ask what PT codes are covered. List thetreatment is based on or consists of a basic
ones you are likely to perform in your office. Ifrelaxation massage, this is the code to use. If,
you are not contracted with the insurance carrierhowever, your intention is to increase pain-free
and do not know what specific codes arerange of motion and facilitate a return to
covered, bill out the PT codes you perform andfunctional activities, use the code 97140. And don't
see if they are covered.forget the modifier!
Some of the most commonly paid and widely97535: Activities of daily living - self-care, home
used Physical Therapy codes:management training - direct one-on-one contact
97010: Hot/cold packs (of late, BCBS and UHCwith the provider, 15 minute units. This can consist
does not pay for this procedure, but some insof giving the patient exercises that he/she can
companies do). Billed as one unit, not timed.perform at home. You can demonstrate the
97110: One-on-one. Exercises to develop strengthexercises and give them a print out with diagrams
and endurance, range of motion and flexibility, oneand directions on it. Some insurance companies
or more areas. Therapeutic exercise incorporatespay, some don't. One small insurance company I
one parameter (strength, endurance, range ofknow of allows 25.00 for 1 unit. Depending upon
motion or flexibility) to one or more areas of thelocation, a DC can bill up to $50.00 per unit, and
body. Examples include treadmill (for endurance),not normally over 1 unit. Perform this service and
isokenetic exercise (for range of motion), eachbill this code only once every 8 weeks or so.
unit is 15 minutes. You can bill up to 3 units.A WORD ABOUT DOCUMENTATION
Depending upon your location, you can charge upDCs are on the hot seat these days with
to $50.00 per unit. Basically, 97110 is any exerciseinsurance carriers because of their lack of proper
your patient performs while he is in your office.documentation. If you don't write it down, you
These include and are not limited to assisteddidn't perform the therapy! Record the type of
stretching, exercises on the ball, hip roll, seatedexercises performed, and if the code is a timed
roll, etc.unit, record the start and end times of your
97112: One-on-one. Neuromuscular re-education oftherapy.