Medical Billing Forum

Billing => Billing => Topic started by: KARREN on May 27, 2010, 08:11:05 AM

Title: 97140 (97140-59 with CMT code)
Post by: KARREN on May 27, 2010, 08:11:05 AM
question 1) Is procudure code 97140 myofascial consider a modality code or therapeutic code?

question 2) billed 98941 CTL &  97140-59 (myofascial regions of the deep seated quadratus lumborum, piriformis and gluteal muscles)
  ins denied 97140-59 stated billed integral component of another procedure code.  Is it okay to appeal this, since 97140 is done to a separate region.  NEED HELP?

question 3) Billed 98941, 97140-59 (myofascial) , 97530,97012,97032,97035.. ins paid all code but denied 97035 stating only 4 mod per day..  but I'm confused about 97140 is that consider a modality code or therapeutic code?

Thanks in advance for this forum and all your help


Title: Re: 97140 (97140-59 with CMT code)
Post by: DMK on May 27, 2010, 10:46:32 AM
1. 97140 is a Therapy Code.

2. 97140-59, I'm having the same trouble.  The -59 indicates that it was a separate therapy from the Adjustment, but some of my Blue Cross policies are bundling it.  I think it would be appropriate to appeal it.  It wasn't palpation of the spine, it was myofascial release.

3. Aetna has this same policy, they only allow 4 therapies/modalities per treatment. 

I'll be very interested to see how this works out for you, I'm frustrated daily by the same thing.  I recently appealed to ASHN (a Chiropractic UR company working for certain Blue Cross groups).  Massage is a covered benefit, but when I bill it with a -59 they deny it, when I re-bill it without the -59 (as the person in the claims department instructed me to) the deny it due to NCCI edits.   Arghhhh!
Title: Re: 97140 (97140-59 with CMT code)
Post by: Michele on May 27, 2010, 09:33:50 PM
When billing for chiros anything other than the manipulation is usually treated as a modality.  We too have the 97140 bundled in with the manipulation, even with the 59 modifier.  They consider any/all modalities to be included in with the manipulation.

Michele
Title: Re: 97140 (97140-59 with CMT code)
Post by: DMK on May 28, 2010, 10:21:01 AM
Electric Muscle Stimulation, Ultrasound, Mechanical Traction, are separate services, and we never have trouble getting paid for these items.  It's only the 97140 or 97124 massage therapy, and it's only certain plans.  It's frustrating though when it is a separate service, it's not just the palpation.

 >:(