Supporting Each Other National studies show that new massage therapists have five years in which to be successful or they stop practicing. I have a few recommendations for our new therapists: • Don’t think of each other as competitors for the same business. There is enough pain for all of us. • Form discussion groups about how you can build the businesses in your area. Listen to what works for others and apply their successful techniques. It is foolish for everyone to have to reinvent the same wheel. • Join at least one professional association. The more the better. They protect your profession from all sorts of political and social challenges. They provide services at rates you cannot equal elsewhere. • Support each other. Some will want to bill for insurance and some think that billing for insurance is the beginning of the end for holistic massage therapy. The more my neighbor therapists succeed, the more people who become aware of the benefits of massage and, therefore, the group of potential clients for me grows. I want the therapists around me to be so successful that they need to send their overflow to me. I’ll send mine to them. — Ed Denning |
Massage Therapy Medical Codes for 2005
By Ed Denning
The American Medical Association (AMA) 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 for massage therapists to use in 2005: 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. It’s 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.
Most automobile insurance companies cover massage therapy. This is a huge market opportunity for you. Educate your clients so that if they are unfortunate enough to have an auto accident, they will know your reimbursed services can be used to speed their recovery from the associated aches and pains.
Coding Guidelines
Do not use codes 97124 and 97140 to bill for massage work during the same session. The Correct Coding Initiative of Medicare has determined that there is not enough difference between these two codes to allow claim of their use in the same therapy session.
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: http://cms.hhs.gov/ physicians/cciedits/default.asp#mutual .
Do not use questionable codes just to build your bill. This is both unethical and a poor business practice and has already resulted in retaliation from an insurance company in one state. That 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 about here 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.
A Bright Insurance Billing Future
Massage therapy now has a representative at the AMA. That representative will be presenting a proposal to AMA for acceptance of two CPT codes specifically for massage therapy. Those codes will be for Massage Therapy Evaluation and Massage Therapy Reevaluation. If they are accepted for inclusion in the CPT manual, it will be well-publicized in this magazine and others. I don’t expect that to happen until the new codes come out for 2006.
There is a set of CPT style codes produced by Alternative Link. They use the letters of the alphabet and are known as ABC codes. A large number of those codes apply to massage and bodywork.
Many organizations are recognizing that the AMA CPT coding system has serious limitations. One of those organizations, Mitchell Medical, has decided to include the ABC codes in their coding software, which is used throughout the auto insurance industry. If the auto insurance industry decides to get on board with these new codes, massage therapy will finally begin to show up in insurance industry statistics.
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, www.MassageCPT.com . For more information, address questions to 330/289-3453 or info@massagecpt.com .
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