Letter to BCBS About the Manual Therapy Code

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

TODAY’S DATE…

BCBS CLAIMS REVIEW DEPARTMENT

re: ENCLOSED EOB'S

DATES OF SERVICE:___________________


Dear BCBS,

I am resubmitting copies of your EOB's on which you have denied the physical medicine procedure "Manual Therapy Technique", CPT code 97140 as being "mutually exclusive of the Chiropractic Manipulation code 98940-42".

The new "Manual Therapy Technique" code was developed to replace several codes: Myofascial release (97250), Joint Mobilization (97250), and Traction, manual (97122). Please understand that the removal of codes does NOT signal that a specific disorder no longer exists...it just forces us, in the field to find a code which "most accurately describes" the service we provide for the illness described on the diagnosis section of the HCFA.

If you look for the deleted codes (such as Myofascial release CPT 97250), in CPT 2000, you will see that it advises the user to now use the new code 97140. Thus, it was the intention of the AMA board of review that these procedures were VALID, but better explained by this combined code...even though the actual wording of the new code leaves something to be desired.

There has been some confusion in that the new code 97140 is described as "a manual therapy technique (eg mobilization, manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes". So, IF someone ignored the diversity of techniques described in this passage, and only singled out the word "manipulation", they might argue that the 2 manipulations were mutually exclusive. BUT, since it is quite evident that this code replaces several other physical medicine codes, all of which have been traditionally covered and paid for by the BCBS contract in the past, it is reasonable to expect to be paid, regardless of the one word "manipulation".

Please resubmit this claim for appropriate payment. This code was used to describe either mobilization of a joint separate from a spinal region which was manipulated (such as an ankle or shoulder), or for delivering myofascial release technique to the separate soft tissue component of their complaint.

If you are formally denying coverage for this procedure, please advise us of that in writing immediately, so that we may find another code which might closely describe the care this patient needs and received or, to bill the patient for non-covered services.


Very truly yours,


Dr. Frank M. Painter, D.C.

BCBS PROVIDER# _________

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