Chiropractic Billing and Physical Therapy

THE GRATUITOUS DISCLAIMER
This article is not intended as a replacement for authorized chiropractic billing educational programs. The author is a Medical Biller and speaks mostly from practical experience as opposed to organized theory-based resources and materials. Certainly it is up to the reader to research the topics discussed with their individual insurance carriers.

ARE YOU LEAVING MONEY ON THE TABLE?
Most chiropractors add physiotherapy to their study courses while training for Chiropractic. Regular Physiotherapy. Unfortunately, many chiropractors do not take advantage of their Physiology licenses and therefore leave money on the table as far as insurance billing is concerned! Although some insurance plans will not cover Physical Therapy performed in the chiropractor's office (such as Medicare), there are plenty that do. If you find yourself too busy to perform therapy for your patient, hire a CA certified in Physiotherapy to handle the Physical Therapy part of their treatment.

More insurance money for you, but WHO ELSE BENEFITS?
Your patient benefits also from PT being performed in your office. It will facilitate their healing process, and if they complete their at home exercises, your patients will be less likely to re-injure themselves. So if you are not performing PT for and on your patients, you are 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 ask for Physical Therapy benefits. Ask if Physical Therapy can be performed by a Chiropractor. If so, then ask if there is a separate deducible. Normally there is not, but you want to be sure. If you are contracted with the insurance carrier, ask what PT codes are covered. List the ones you are likely to perform in your office. If you are not contracted with the insurance carrier and do not know what specific codes are covered, bill out 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 (of late, BCBS and UHC does not pay for this procedure, but some ins companies do). Billed as one unit, not timed.

97110: One-on-one. Exercises to develop strength and endurance, range of motion and flexibility, one or more areas. Therapeutic exercise incorporates one parameter (strength, endurance, range of motion or flexibility) to one or more areas of the body. Examples include treadmill (for endurance), isokenetic exercise (for range of motion), each unit is 15 minutes. You can bill up to 3 units. Depending upon your location, you can charge up to $50.00 per unit. Basically, 97110 is any exercise your patient performs while he is in your office. These include and are not limited to assisted stretching, exercises on the ball, hip roll, seated roll, etc.

97112: One-on-one. Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities, one or more areas. This code is intended to identify neuromuscular re-education, designed to re-educate the muscle for some function it was previously able to do (not intended to identify massage to increase circulation, etc). This will usually be in the form of some commonly performed task for that body part. 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 be sure it is medically necessary!

97140: One-on-one. Manual therapy techniques - myofacial 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 from 1 to 3 units.

97140 is used to describe therapy which increases active pain-free range of motion, increased extensibility of myofascial tissue and facilitates return to functional activities. This code is reported in units of 15 minutes. It would include neuromuscular therapy, positional release, stretching and nearly any therapeutic technique performed manually for the purposes mentioned above. This therapy is to be performed on an area separate and apart from the area of main complaint in order to successfully bill to insurance. Append the 59 modifier to this code.

97124: One-on-one Massage, including effleurage, petrissage and/or stroking, compression, percussion, one or more areas, each 15 minutes

The main difference between 97124 and 97140 is the intention of the therapy.

If the therapist is performing therapeutic massage in order to increase circulation and promote tissue relaxation to the muscles, then use code 97124. If treatment is based on or consists of a basic relaxation massage, this is the code to use. If, however, your intention is to increase pain-free range of motion and facilitate a return to functional activities, use the code 97140. And don't forget the modifier!

97535: Activities of daily living - self-care, home management training - direct one-on-one contact with the provider, 15 minute units. This can consist of giving the patient exercises that he/she can perform at home. You can demonstrate the exercises and give them a print out with diagrams and directions on it. Some insurance companies pay, some don't. One small insurance company I know of allows 25.00 for 1 unit. Depending upon location, a DC can bill up to $50.00 per unit, and not normally over 1 unit. Perform this service and bill this code only once every 8 weeks or so.

A WORD ABOUT DOCUMENTATION
DCs are on the hot seat these days with insurance carriers because of their lack of proper documentation. If you don't write it down, you didn't perform 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.