By Ed Denning
The American Medical Association produces a manual each year that contains thousands of codes for known medical procedures. This procedures manual is revised yearly due to the ever-changing field of medicine. The manual is intended for physicians, but from inception other medical modalities have used the codes to describe the work they do. Combined with the World Health Association’s International Classification of Disease (ICD) codes, the Current Procedural Terminology (CPT) codes offer a concise and accurate description of the medical professional’s actions.
Massage therapists use a few codes from the Physical Medicine and Rehabilitation section of the CPT manual. Since massage therapists do not diagnose conditions, the ICD code must be acquired from a prescribing medical specialist.
The following CPT codes are still legitimate CPT codes for massage therapists to use in 2004: 97010 — Hot and cold packs; 97124 — Massage; 97140 — Manual therapy.
The following two codes are for reporting unlisted procedures and, although they could be used, require written documentation and are unlikely to result in payment: 97039 — Unlisted modality (used to report the incorporation of massage tools that mimic the action of the hands: hand-held electronic devices, trigger point tools, etc.); 97139 — Unlisted therapeutic procedure (used to report qigong, shiatsu, etc.).
It is the massage therapist’s responsibility to always use the correct CPT code.
Being paid for an improper CPT code does not mean it is an appropriate code for you to use. In a worse case scenario, a company or agency that discovers you are being paid for an improper code could insist on repayment of those improperly earned fees as far back as seven years. Not likely to happen, but why put your practice at such risk? Use only those codes recommended by experts who can provide verification of their opinions.
Many massage therapists still do not know that all automobile insurance companies cover massage therapy. This is a huge market opportunity wherever you are. Educate your clients so that if they are unfortunate enough to have an auto accident they will know your services can be used to speed their recovery from the associated aches and pains.
Make sure you know which codes can be paired and which can’t. You can download a table of mutually exclusive edits (meaning codes that shouldn’t be used together). This table is current through the end of 2003. The code of 97140 (Manual therapy techniques) is mentioned with several other chiropractic codes that shouldn’t be used simultaneously.
If you want more information, there are guidelines spelled out by the Centers for Medicare and Medicaid Services (which publishes the Correct Coding Initiative [CCI]). They have listed their most recent edits on their website: cms.hhs.gov/physicians/cciedits/default.asp#mutual.
Do not use questionable codes just to build your bill. This is unethical. It is a very poor business practice and has already resulted in retaliation from an insurance company in one state. This insurance company now only accepts 97124 and pays only its set amount. Codes that fall into this questionable category are: 97110, 97112, 97530, 97001-97006 (which are codes dealing with evaluation and re-evaluation) and any code that begins with 99 (which should only be used by physicians).
When you hear someone’s opinion on coding, make sure to ask for accompanying documentation. This author can document every opinion regarding CPT codes written in this article and your source should also be able to provide documentation for their recommendations. It’s important not to make coding decisions based on personal opinions.
It’s also important to note that someone using additional codes may have another level of training you don’t. For instance, there are people using 97110 (Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility). They are using this code to cover techniques such as muscle energy technique, facilitated stretching, pin and stretch, active release or active engagement methods, etc. These are legitimate uses of this code if, in fact, the practitioner has subsequent training, for instance, in occupational therapy.
Ed Denning, an instructor in the massage therapy department at Stark State College of Technology, is a licensed massage therapist in Ohio with a part-time practice. He also maintains a website primarily concerned with coding and billing, MassageCPT.com. For more information, address questions to firstname.lastname@example.org or 330/289-3453.
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