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Marty Kotlar, DC, CPCO, CBCS

Marty Kotlar, DC, CPCO, CBCS

Question:  Dr. Kotlar, I’ve been doing chiropractic extra-spinal manipulation on my patients, however, I do not know how to bill insurance for this service.  Can you help?

Answer:  Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. This treatment may be accomplished using a variety of techniques.  The chiropractic manipulative treatment codes include a pre-manipulation patient assessment.  Additional Evaluation and Management services may be reported separately using the modifier 25 if, and only if, the patient’s condition requires a significant, separately identifiable E/M service, above and beyond the usual pre-service and post-service work associated with the procedure.  The E/M service may be caused or prompted by the same symptoms or condition for which the CMT service was provided. As such, different diagnoses are not required for the reporting of the CMT and E/M service on the same date.

For purposes of CMT, the five spinal regions referred to are: cervical region (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region.

The five extraspinal regions referred to are: head (including temporomandibular joint, excluding altanto-occipital) region; lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints) and abdomen.

CPT Codes

  • 98940: chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • 98941: spinal, 3-4 regions
  • 98942: spinal, 5 regions
  • 98943: extraspinal, 1 or more regions

When submitting claims for CPT code 98943, make sure to have at least the following three items in the initial documentation in order to prove medical necessity; 1) the patient’s history/subjective complaints, 2) your examination findings, 3) at least one extremity diagnosis.  If you would like to receive a sample extremity manipulation letter of medical necessity, send an email to info@targetcoding.com.

Example shoulder ICD-10 codes include:

  • M25.511: Pain, right
  • M25.512: Pain, left
  • M25.611: Stiffness, right
  • M25.612: Stiffness, left
  • M75.01: Adhesive capsulitis, right
  • M75.02: Adhesive capsulitis, left
  • M75.51: Bursitis, right
  • M75.52: Bursitis, left
  • S46.011_: Strain, rotator cuff, right side
  • S46.012_: Strain, rotator cuff, left side

Marty Kotlar, DC, CPCO, CBCS is the President of Target Coding. Dr. Kotlar is Certified in CPT Coding, Certified in Healthcare Compliance and has been helping chiropractors nationwide with billing, compliance, coding and documentation for over 10 years. Target Coding can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – info@targetcoding.com.