THE FREE WAIVER
This article is not intended to replace authoritative chiropractic billing educational programs. The author is a medical biller and speaks primarily from practical experience rather than organized theory-based resources and materials. It is certainly up to the reader to research the issues discussed with their individual insurance companies.
ARE YOU LEAVING MONEY ON THE TABLE?
Most chiropractors add physical therapy to their courses of study while training for chiropractic. Regular physiotherapy. Unfortunately, many chiropractors do not take advantage of their physiology licenses and thus leave money on the table when it comes to insurance billing. Although some insurance plans will not cover physical therapy performed in a chiropractor’s office (such as Medicare), there are many that do. If you find yourself too busy to perform therapy for your patient, hire a Certified Physical Therapy CA to handle the physical therapy portion of their treatment.
More insurance money for you, but WHO ELSE BENEFITS?
Your patient also benefits from having physical therapy performed in your office. It will facilitate your healing process, and if they complete their exercises at home, your patients will be less likely to re-injure themselves. So if you’re not performing PT for your patients, you’re doing yourself and them a disservice.
Check your PT coverage
When you, your staff, or your billing service verify chiropractic insurance benefits, be sure to specifically request physical therapy benefits. Ask if physical therapy can be performed by a chiropractor. If so, ask if there is a separate deductible. Usually there isn’t, but you want to be sure. If you have a contract with the insurance company, ask what PT codes are covered. List the ones you are likely to do in your office. If you don’t have a contract with the insurance company and don’t know what specific codes are covered, bill the PT codes you perform and see if they are covered.
Some of the most commonly paid and widely used physical therapy codes:
97010: hot/cold packs (lately, BCBS and UHC do not pay for this procedure, but some insurance companies do). Billed as a unit, not timed.
97110: One on one. Exercises to build strength and endurance, range of motion, and flexibility, one or more areas. Therapeutic exercise incorporates a parameter (strength, endurance, range of motion, or flexibility) to one or more areas of the body. Examples include treadmill (for resistance), isokenetic exercise (for range of motion), each unit is 15 minutes. You can invoice up to 3 units. Depending on your location, you may charge up to $50.00 per unit. Basically, 97110 is any exercise your patient does while you’re in her office. These include and are not limited to assisted stretching, ball exercises, hip rocking, seated rocking, etc.
97112: One on one. Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture and/or proprioception for sitting and/or standing activities, in one or several areas. This code is intended to identify neuromuscular re-education, designed to re-educate the muscle for some function that it was previously able to perform (it is not intended to identify massage to increase circulation, etc.). This will usually be in the form of some task commonly performed for that part of the body. 15 minute units. (Examples: feldenkreis, bobath, bap’s boards, desensitization techniques…) Sometimes you will be asked for notes proving medical necessity if you use this code, so make sure it is medically necessary!
97140: One on one. Manual therapy techniques – myofascial release, mobilization/manipulation, manual lymphatic drainage, manual traction, trigger point – one or more regions, 15 minute units, charges can be up to $50.00 per unit, and a good average is 1 to 3 units.
97140 is used to describe therapy that increases pain-free active range of motion, increases myofascial tissue extensibility, and facilitates return to functional activities. This code is reported in units of 15 minutes. It would include neuromuscular therapy, positional release, stretching, and just about any therapeutic technique performed manually for the purposes listed above. This therapy must be performed in an area separate and apart from the main complaint area in order to properly bill insurance. Add modifier 59 to this code.
97124: One-on-one massage, including rubbing, petrissage and/or caresses, compression, percussion, one or more areas, every 15 minutes
The main difference between 97124 and 97140 is the intent of the therapy.
If the therapist is performing a therapeutic massage for the purpose of increasing circulation and promoting relaxation from the tissues to the muscles, use code 97124. If the treatment is based on or consists of a basic relaxation massage, this is the code to use. However, if your intent is to increase range of motion without pain and to ease return to functional activities, use code 97140. And don’t forget the modifier!
97535: Activities of Daily Living – Personal Care, Home Management Training – Direct One-on-One Provider Contact, 15 minute units. This may consist of giving the patient exercises that they can do at home. You can demonstrate the exercises and give them a printout with diagrams and instructions. Some insurance companies pay, some don’t. A small insurance company I know of allows 25.00 for 1 unit. Depending on location, a DC may bill up to $50.00 per unit and typically no more than 1 unit. Perform this service and bill this code only once every 8 weeks or so.
A WORD ABOUT DOCUMENTATION
DCs are in the hot seat these days with insurance companies due to their lack of proper documentation. If you don’t write it down, you didn’t do the therapy! Record the type of exercises performed and, if the code is a timed unit, record the start and end times of your therapy.
