Complaints About Compliant Extremity CMT Billing

Complaints about Compliant Extremity CMT Billing are common and have a major impact on the reimbursement and cash flow of many chiropractic practices. This is a complex issue that has been addressed by some payers, such as Optum for Veterans Affairs patients. However, it is still not clear when an E/M service must be separately reported from CMT services performed on the spine.

This is particularly difficult with extreme CMT, where the source of pain or discomfort may be in a region outside of the spinal segment that receives manual therapy and an adjustment. Documenting these conditions requires a detailed examination of the entire body, which can be a time-consuming process that may detract from your patients’ treatments and may also be confusing to your records staff.

Payers and re-billing agencies have clarified when it is appropriate to use the 59 modifier when performing CMT along with 97140 – manual therapy techniques (manipulation, mobilization, manipulation/mobilization or manual lymphatic drainage and/or manual traction) on one or more regions (15 minutes each). This clarification has loosened some of the tight noose that was felt by doctors of chiropractic in the past and may help providers understand what needs to be documented in order for these services to be billed together.

However, there are still some physicians who fail to correctly use this modifier and therefore run the risk of having their claims denied or rejected. The use of the 59 modifier is essential for demonstrating to the payer that these two distinct procedures were performed in separate anatomic sites and that they are therefore medically necessary.

It is important to remember that the 97140 spinal CMT codes are considered “column two” procedures in terms of the CMS Global Surgery Period rules, so it is very important that any documentation supports the use of these code combinations. If you are using these codes on a regular basis, it is recommended that you consult your payers for their coding guidelines and billing policies.