1) IT’S OKAY TO BILL 98942
CPT code 98942 is a 5-region spinal adjustment. The five regions include cervical, thoracic, lumbar, sacrum and pelvis. It’s not that common, however I’m sure you have had patients enter your office and say “everything hurts.” This patient has symptoms in all five regions.
If your exam, diagnosis and documentation are sufficient,
then go ahead and bill 98942.
Upon re-exam, if the patient states that one region has cleared out, then revise your billing to 98941.
2) CPT CODE 97530
Have you ever thought about billing 97530? CPT code 97530 is therapeutic activities. This code is very different from 97110, therapeutic exercises. Let me explain…
To begin with, both codes are considered therapeutic procedure codes – this is a manner of effecting change through the application of clinical skills and/or services that attempt to improve function. You are required to have direct (one-on-one) patient contact.
The intent of 97110 is to improve one or more of the following outcomes: 1) flexibility, 2) ROM, 3) strength, 4) endurance. Therapeutic exercises are performed by the patient in an active approach (e.g., balls, bands, tubing, weight lifting). The patient is doing the exercise, not just getting stretched. Documentation should include not only measurable indicators such as functional loss of joint motion or muscle strength, but also information on the impact of these limitations on the patient’s life and improvement in one or more of these measures leads to improved function. Documentation should describe new exercises or changes made to the exercise program to help justify that the services are skilled. If this sounds overwhelming to document, don’t fret – contact us and we’ll show you how to make it easy.
The intent of 97530 is to improve function through the use of dynamic activities. This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, and overhead activities) to improve functional performance in a progressive manner.
The exercises are usually directed at a loss or restriction of mobility, strength, ROM, balance, endurance, proprioception, coordination. Therapeutic activities can be thought of as the “ing” code – dynamic activities that work towards functional performance with lifting, bending, pushing, pulling, jumping and reaching. Example: increase flexibility of the quadratus lumborum muscles while activating and stretching the hamstring muscles to improve the patient’s capacity for walking and standing.
Here again, if this appears complicated, contact us for a free consultation. Also, if you’re looking for therapy treatment plan templates, purchase our Customizable Forms & Templates Product. Click for info:
3) BILL FOR MORE THAN 1 UNIT
Non time-based codes such as 97012 cannot be billed for more than one unit because they do not require “one-on-one” patient contact. Time-based codes such as 97110, 97112, 97124 and 97140 require one-on-one constant attendance – this means you or your CA must be with the patient for the entire time.
Many offices are afraid to bill more than one unit or don’t think they’ll get paid.
If patients have advanced, recurrent or chronic conditions,
they could benefit from more than one unit.
On the other hand, if a patient presents with a simple/minor condition, then yes, only bill one unit. Example: a patient enters your office with a condition that is going on for more than 3 month (chronic), has tried other therapies that failed, has complicating factors and co-morbidities, then bill for 2, 3 or even 4 units to start and as the patient progresses, reduce the units upon each re-exam.\
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