b'your claim forms and point each of them to only one of the97014 (electric stim) performed with CMT (98940-3)CPT codes you are billing for that day. It explains the reason97035 (ultrasound) performed with CMT (98940-3)you are performing the particular CPT code. See illustration at bottom of page: 97110 (therapeutic exercise) performed with CMT (98940-3)Documentation: 97140 (manual therapy) performed with Extraspinal CMT It is very important that your documentation supports any time(98943)*you use either of the above modifiers. Key aspects to include in97530 (therapeutic activities) performed with CMT (98940-3)your documentation are as follows:Make sure the patients complaint(s) and diagnosis support98943 (extraspinal manipulation) performed with CMT (98940-2) the use of the therapy. * Some payers do require -59 modifier when 97140 is billed with Include the specific type therapy (e.g. trigger point therapy,98943 myofascial release, etc.) in your notes and treatment planThe key to remember is that documentation determines the use (include goals, frequency and duration).of a modifier, not reimbursement. For more information, please Document exactly which muscles or other anatomical struc- see the National Correct Coding Initiative Edits at: tures you addressed with the therapy and specific segmentalhttp://www.cms.gov/Medicare/Coding/NationalCorrectCodI-levels adjusted. nitEd/index.htmlDocument the time spent to the minute performing theEvery office handles coding and documentation differently,therapy (e.g. 13 minutes spent). however all providers should have safeguards in place to Make sure to diagnosis point on the claim form. ensure that proper coding rules are followed. Billers and coding The above scenarios are not the only times that providersprofessionals should not simply add modifiers without first should use modifiers. To help with proper modifier usage I haveconfirming that a modifier is required for proper reimbursement created a chart of commonly used codes by chiropractic officesand second, if it is required, make sure that the providers and using NCCI, identified any coding combinations that, if thedocumentation supports its use. circumstances support its use, require the -59 modifier: I know of many offices where billing personnel add modifiers Below is a list of Common scenarios that DO just in case they might be needed. Or they have a billing require modifiers: company that adds modifiers for the provider. This practice is 99201-99215 (E/M) performed with CMT (98940-3)highly inappropriate without first confirming any modifications/99213 then requires modifier -25additions to codes with the provider. Additionally, providers should never have modifiers pre-loaded or attached to codes 97140 (man therapy) performed with CMT (98940-3) 97140 on a fee sheet or automatically added by software. then requires modifier -59 97140 (man therapy) performed with traction (97012)The rules for modifiers are very clear and well-established. 97140 then requires modifier -59 Understanding how and when they are supposed to be used will help ensure your practice does not inadvertently create a 97112 (neuro re-ed) performed with CMT (98940-3)97112 negative profile and help to avoid a potential audit.then requires modifier -59 97124 (massage) performed with CMT (98940-3)David Klein, CPC, CPMA, CHC, is co-founder of PayDC, a web-based 97124 then requires modifier -59 fully certified EHR system that focuses on compliance and reimburse-97140 (man therapy) with therapeutic activities ment. He is a certified professional coder and certified professional (97530)97530 then requires modifier -59medical auditor through the American Academy of Professional Coders Below is a list of Common scenarios that DO NOT (AAPC), and is certified in healthcare compliance through the Health require modifiers: Care Compliance Board (HCCB). He is the Founder and President of DK Coding & Compliance, Inc., a healthcare consulting firm that focuses on 97012 (traction) performed with CMT (98940-3) audit defense, education, compliance and reimbursement issues. www.njchiropractors.com I 15'