Re: CPT 97140-59 for Myofascial Release

[Guest guest]

Vern,

I strongly recommend that all chiropractors buy the ChiroCode book and Hot Topics Newsletter from the ChiroCode Institute. They are all over this stuff, even more so than ACA.

Myofascial release or trigger point therapy can be billed with -59 and should be reimbursed as long as it is documented to be of non-paraspinal muscles. Work to the paraspinal muscles would be considered part of the 98940 series and could not be billed separately.

Yours,

DR. COBY L. HANES991 NE THIRD STREETPRINEVILLE, OR 97754voice: 541.447.7230fax: 541.447.5775dochanes@...

-----Original Message-----From: Vern Saboe [mailto:vas@...] Sent: Friday, April 16, 2004 3:14 PMACA-Members@...; nbofe ; Subject: "CPT 97140-59 for Myofascial Release"

Dear colleagues/coding experts:

We have a claims adjuster for Liberty Northwest (this is an auto claim) that is telling a colleague that it is inappropriate for her to bill 97140-59 even with this modifier for her 10-15 hands on myofascial release she performs in addition to the chiropractic spinal manipulation e.g, 98940.

I don't use this code, nor do I have a real handle on coding in the first place, my gal handles all of this in our clinic etc., etc. etc.

So could someone tell me the scoop on this, I know this has been discussed prior....but me mind was on golf or politics I'm sure!

Vern Saboe, DC

OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

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[Guest guest]

Thanks so much Coby, thanks for taking the time to reply.

Vern

RE: "CPT 97140-59 for Myofascial Release"

Vern,

I strongly recommend that all chiropractors buy the ChiroCode book and Hot Topics Newsletter from the ChiroCode Institute. They are all over this stuff, even more so than ACA.

Myofascial release or trigger point therapy can be billed with -59 and should be reimbursed as long as it is documented to be of non-paraspinal muscles. Work to the paraspinal muscles would be considered part of the 98940 series and could not be billed separately.

Yours,

DR. COBY L. HANES991 NE THIRD STREETPRINEVILLE, OR 97754voice: 541.447.7230fax: 541.447.5775dochanes@...

-----Original Message-----From: Vern Saboe [mailto:vas@...] Sent: Friday, April 16, 2004 3:14 PMACA-Members@...; nbofe ; Subject: "CPT 97140-59 for Myofascial Release"

Dear colleagues/coding experts:

We have a claims adjuster for Liberty Northwest (this is an auto claim) that is telling a colleague that it is inappropriate for her to bill 97140-59 even with this modifier for her 10-15 hands on myofascial release she performs in addition to the chiropractic spinal manipulation e.g, 98940.

I don't use this code, nor do I have a real handle on coding in the first place, my gal handles all of this in our clinic etc., etc. etc.

So could someone tell me the scoop on this, I know this has been discussed prior....but me mind was on golf or politics I'm sure!

Vern Saboe, DC

OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

---Incoming mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.658 / Virus Database: 422 - Release Date: 4/13/2004

---Outgoing mail is certified Virus Free.Checked by AVG anti-virus system (http://www.grisoft.com).Version: 6.0.658 / Virus Database: 422 - Release Date: 4/13/2004

[Guest guest]

Hi Vern, I use that coding on almost every auto accident and have never been denied. Using the -59 modifier distinctly indicates that this is a separate procedure from 98940 and should absolutely be re-imbursed. However, if i was ever denied, I don't imagine i would have a clue on how to convince the obstinate adjuster that i must be re-imbursed. Maybe referencing the coding book that Dr. Hanes has recommended is the answer. For what its worth.

DC Joe Medlin

PDX

"CPT 97140-59 for Myofascial Release"

Dear colleagues/coding experts:

We have a claims adjuster for Liberty Northwest (this is an auto claim) that is telling a colleague that it is inappropriate for her to bill 97140-59 even with this modifier for her 10-15 hands on myofascial release she performs in addition to the chiropractic spinal manipulation e.g, 98940.

I don't use this code, nor do I have a real handle on coding in the first place, my gal handles all of this in our clinic etc., etc. etc.

So could someone tell me the scoop on this, I know this has been discussed prior....but me mind was on golf or politics I'm sure!

Vern Saboe, DC

OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Hello all,

Farmers tried this move on us last year. With an extreme letter writing campaign with countless documents and complaints to the Insurance Commissioner by our patient we finally got them to back off. They were trying to use the Medicare rules, as their system started using NCCI Medicare Edits recently and some of their inexperience adjusters didn't know to ignore them. Under NCCI's strict rules a DC can't perform that procedure, if it is for the same DX (why Medicare?because in some states a PT can do 98940 and 97124 and 97140 and Medicare needed to restrict services). However, this is not supported by the ACA or our Scope of License and there is no court of law that will allow an auto carrier to use NCCI Medicare edits to deny the claim. I would be happy to forward copies of all our correspondence to the person having a hard time and it may help them, but to win you must show that you know more than they do and you must get the patient involved as well.

The AMA allows the procedure with the same DX but different areas/regions worked, such as unique muscles groups that are near the area you are manipulation, groups must be listed in chart notes and it can be hard to get a carrier to get passed the AMA rule, but the ACA doesn't support it. The problem also stems from the fact that the AMA who writes the CPT code book has put the words massage and manipulation along with code 97140 and know that mod -59 means many different things(read the description in the CPT code book) and with such vague information in the CPT book an insurance carrier can take it upon themselves to decide what distinct means and there are three versions; Medicare's, the AMA's and the ACA's. In addition, some other carriers like Farmers will also try this with 97124 and require -59, but don't ever let an Adjuster tell you it has to be for a different DX, the -59 is for one reason only, to override their stupid edit system, that they haven't yet figured out that it is not really legal for Chiro let alone PT for any MVA, but until they get sued ( or someone gets a law passed in Oregon) enough they will continue use the NCCI Edit to deny claims to the uneducated offices. I have a letter from a Farmer's supervisor which dispels their devious method, but the adjuster will try to fool you into thinking that they know more and that they are the ultimate authority, which is why I finally got the letter and it came because of the complaint to the Insurance Commissioner.

I just need the fax number of the office that is having the problems and they can fight it with what I have, or all the documentation is on the internet too. If they are a Chirocode member there is plenty on their site and the ACA has numerous references too, which most can be downloaded free and they will get involved with any carrier that is being downright nasty.

Good luck,

Stockton

"CPT 97140-59 for Myofascial Release"

Dear colleagues/coding experts:

We have a claims adjuster for Liberty Northwest (this is an auto claim) that is telling a colleague that it is inappropriate for her to bill 97140-59 even with this modifier for her 10-15 hands on myofascial release she performs in addition to the chiropractic spinal manipulation e.g, 98940.

I don't use this code, nor do I have a real handle on coding in the first place, my gal handles all of this in our clinic etc., etc. etc.

So could someone tell me the scoop on this, I know this has been discussed prior....but me mind was on golf or politics I'm sure!

Vern Saboe, DC

OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Great post very very helpful.

Vern Saboe

"CPT 97140-59 for Myofascial Release"

Dear colleagues/coding experts:

We have a claims adjuster for Liberty Northwest (this is an auto claim) that is telling a colleague that it is inappropriate for her to bill 97140-59 even with this modifier for her 10-15 hands on myofascial release she performs in addition to the chiropractic spinal manipulation e.g, 98940.

I don't use this code, nor do I have a real handle on coding in the first place, my gal handles all of this in our clinic etc., etc. etc.

So could someone tell me the scoop on this, I know this has been discussed prior....but me mind was on golf or politics I'm sure!

Vern Saboe, DC

OregonOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.