The Practice Building Alliance™

Medical Insurance Techniques, Questions and Training

Pat Atanas CA Training

Billing an Adjustment Code Like The 98941 Code

CALLER QUESTION: Can we, instead of billing an adjustment code like the 98941 code, on any given day, say we would render that service, but instead of billing that code, could we actually bill an office visit instead?

John: No, and I’ll tell you why. A couple different reasons. First of all, the introduction to the CPT Code Book says to bill the code that accurately describes the service that you provided. Now, I realize that if you provide a service like manipulation, there’s going to be more than one code that you can actually bill.

For example, you perform a manipulation, you could bill a chiropractor manipulative treatment, an osteopathic manipulative treatment, you could bill a 97140; that’s manipulation as well. Answering that, the office visits are really reserved for patients who come in with a new condition and you need to evaluate them or they have a condition that they’re coming in periodically to get checked.

Caller: I guess my contention, to some degree, would be this: we still have to go ahead and write up the various notes on that office visit. The 98941 or 98940, that applies, I think, directly to the process or the manipulation of the individual.

John: Actually that’s a good question. The chiropractic manipulative treatment codes, even the osteopathic codes, and this extends also to any therapeutic procedure like therapeutic exercises, neuromuscular reeducation, aqua therapy massage, the code includes the pre-service, the intra-service and the post-service, which includes your evaluation of the patient, updating them, performing the adjustment or whatever the service might be, and then also documenting that service after the code has been performed.

And it brings up another issue that I might as well touch on right now. In the new 2010 CPT Code Book, every single code in the book actually has a reference to the CPT Assistant, which is kind of like an ancillary publication that the AMA puts out from time to time.

I’d strongly recommend that not only you get an updated CPT Code Book every single year, but you also invest in the CPT Assistant. Any code that you use, you take a look and see what CPT Assistant was referenced. They’re articles that are written by the AMA, but they’ll have something like “98:” and they’ll have a number, and basically that’s letting you know what year, what addition, what page they address this.

Because in the CPT Code Book, it doesn’t tell you what I just told you about the pre, the intra, and the post. But if you look under the 98940 code now, it will make reference to articles in the CPT Assistant about that code that has been addressed. You’ll see that that’s one of the questions that has been either posed and answered, but that’s the position of the AMA. It’s a really great question, though, because when you go through an audit or an investigation, this becomes a real prickly issue. And I have seen doctors who have used the E&M codes exclusively, and be accused of committing fraud. So, you want to avoid that.

Next post: