Marty Kotlar, DC, CPCO, CBCS
Question: Dr. Kotlar, “I treat a lot of extremity conditions. On some patients, I will adjust multiple extremities. Example, a rotator cuff strain, golfers elbow and iliotibial band all on one visit. How do I compliantly code and bill for this?
Answer: Let’s begin with a little coding and documentation background. According to the American Medical Association, chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. The CMT codes include a pre-manipulation patient assessment. Additional evaluation and management (E/M) services may be reported separately using modifier 25, if the patient’s condition requires a separate E/M service, above and beyond the usual pre-service and post-service. The E/M service may be caused or prompted by the same symptoms or condition for which the CMT service was provided. As such, different diagnoses are not required for the reporting of the CMT and E/M service on the same date.
For purposes of CMT, the five spinal regions referred to are: cervical region (includes atlanto-occipital joint); thoracic region (includes costovertebral and costotransverse joints); lumbar region; sacral region; and pelvic (sacro-iliac joint) region.
The five extraspinal regions referred to are: head (including temporomandibular joint, excluding altanto-occipital) region; lower extremities; upper extremities; rib cage (excluding costotransverse and costovertebral joints) and abdomen.
CMT Codes:
98940: spinal, 1-2 regions
98941: spinal, 3-4 regions
98942: spinal, 5 regions
98943: extraspinal, 1 or more regions
Common Extremity ICD-10 codes:
M25.511: Pain, right shoulder
M25.512: Pain, left shoulder
M75.01: Adhesive capsulitis, right
M75.02: Adhesive capsulitis, left
M75.51: Bursitis, right shoulder
M75.52: Bursitis, left shoulder
M77.01: Medial epicondylitis, right
M77.02: Medial epicondylitis, left
M77.11: Lateral epicondylitis, right
M77.12: Lateral epicondylitis, left
G56.01: Carpal tunnel syndrome, right
G56.02: Carpal tunnel syndrome, left
G56.03: Carpal tunnel syndrome, bilateral
M70.71: Bursitis, right hip
M70.72: Bursitis, left, hip
M76.31: Iliotibial band syndrome, right
M76.32: Iliotibial band syndrome, left
M76.51: Patellar tendinitis, right
M76.52: Patellar, tendinitis, left
S76.111_: Strain, quadriceps, right
S76.112_: Strain, quadriceps, left
M72.2: Plantar fasciitis
M77.31: Calcaneal spur, right
M77.32: Calcaneal spur, left
Q66.51: Congenital flat foot, right
Q66.52: Congenital flat foot, left
The answer to your question is to report code 98943, regardless of how many extremities you are treating because in the definition of the code it states “1 or more regions.” In my opinion, this is unfair and incorrect. There should be separate codes and fees for evaluation and treatment of extremities based on the amount of regions just like with the spinal manipulation codes.
When documenting and submitting claims for 98943, make sure to have at least the following three items in the patient record; 1) the history/subjective complaints, 2) examination findings, 3) at least one extremity diagnosis. If you would like to receive a sample extremity letter of medical necessity, send an email to info@targetcoding.com.
Marty Kotlar, DC, CPCO, CBCS is the President of Target Coding. Dr. Kotlar is Certified in CPT Coding, Certified in Healthcare Compliance and has been helping chiropractors nationwide with billing, HIPAA compliance, coding and documentation for over 10 years. Target Coding can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – info@targetcoding.com.
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