CPT (Current Procedural Terminology) codes are critical in the healthcare industry for streamlining communication and ensuring seamless billing processes. This article focuses on CPT code 97140, a specific code used by occupational therapists for billing manual therapy techniques.
Understanding CPT Code 97140
The American Medical Association (AMA) defines CPT code 97140 as the application of manual therapy techniques to one or more regions for each unit of 15 minutes. Manual therapy techniques may involve manipulation, mobilization, manual lymphatic drainage techniques, and manual traction. These hands-on techniques are used to examine, measure, or manipulate areas of the body to enhance functional performance or manage pain.
To bill for this code, therapists should have related goals for how manual therapy will improve the function of the specific body region to accompany the medical necessity of procedures billed.
Indications for Manual Therapy
In general, manual therapy is recommended for pain in the musculoskeletal system that is caused by mechanical factors, meaning the pain is triggered and alleviated by certain movements or positions. Various types of manual therapy techniques may have their own particular indications.
Key Requirements for Billing CPT Code 97140
There are a few essential requirements and considerations for using this code in practice to ensure correct coding and reimbursement for your time. These include:
Having related goals for how manual therapy will improve function.
Documenting clinical necessity such as the clinical indication of billed techniques.
Describing the exact technique used (joint manipulation, myofascial release, etc.).
Identifying the location (shoulder, elbow, hand, etc.), and the time required.
Including a start and end time for the total session to accompany your charges.
Physical Therapy CPT Code 97140
Manual therapy is considered “hands-on” therapy, meaning the therapist applies a skilled technique to address a specific physical condition.
Common Manual Therapy Techniques
Physical therapy services covered by CPT code 97140 include the following:
Soft-tissue techniques | Joint techniques |
Manual trigger point therapy | Joint mobilization |
Manual lymph drainage | Joint manipulation/thrust |
Transverse frictional massage | Muscle energy techniques |
Soft tissue mobilization | Mobilizations with movement (Mulligan techniques) |
Functional mobilization | Post-isometric relaxation |
Scar mobilization | |
Myofascial release | |
Strain-counter-strain (positional release) | |
Craniosacral therapy | |
Active Release Technique (ART) | |
Feldenkrais | |
Augmented soft-tissue mobilization (eg, Graston) |
Maximizing Reimbursement for 97140 CPT Code
Common reimbursement issues may include modifier usage, unit calculation, reporting measurable outcome data and incomplete documentation.
Documentation for Manual Therapy CPT Code 97140
Key documentation elements for reimbursement success include ensuring outcome measures, progress toward goals, medical necessity, which technique was used, and where and how the patient responded are included in your documentation. The following criteria (for most payors) must be documented to support the clinical necessity of manual therapy services:
• The clinical indication and appropriateness of the selected Manual Therapy Technique (MTT)
• Description of the manual therapy technique e.g., joint manipulation, myofascial release,
mobilization, etc.
• Location e.g., spinal region(s), shoulder, thigh, etc.
• Time (This applies only to CPT code 97140, which includes a timed-therapy services requirement)
Can you bill cpt code 97140 and 97012 together?
Yes, you can bill 97140 and 97012 together. However, it's important to note that billing these codes together requires the use of modifier 59 to indicate that the services were separate and distinct. This is because both codes fall under the category of "physical medicine and rehabilitation services," and without the modifier, the claim may be denied due to the National Correct Coding Initiative (NCCI) edits.
What is the 8-minute rule for 97140?
The 8-minute rule for 97140 refers to the minimum time required to bill for this code. According to CPT guidelines, each timed code represents 15 minutes of treatment. If the duration of treatment surpasses increments of 15 minutes, and there are at least 8 minutes left, you may round up to the next complete unit.
Example:
35 minutes of Manual Therapy (97140):
The first 15 minutes count as one unit.
The next 15 minutes also count as one unit.
The remaining 5 minutes do not meet the 8-minute threshold for an additional unit.
Therefore, for 35 minutes of manual therapy (97140), you would bill a total of 2 units.
38 minutes of Manual Therapy (97140)
The first 15 minutes count as one unit.
The next 15 minutes also count as one unit.
The next 8 minutes meet the 8-minute threshold for an additional unit.
Therefore, for 38 minutes of manual therapy (97140), you would bill a total of 3 units.
What is the difference between 97110 and 97140?
CPT code 97110 is used for therapeutic exercises to develop strength, endurance, range of motion, and flexibility. On the other hand, CPT code 97140 is used for manual therapy techniques that require direct (one-on-one) patient contact. The key difference lies in the type of therapy provided, with 97110 focusing on exercises and 97140 on hands-on techniques.
Conclusion
In summary, CPT code 97140 allows therapists to bill for timed, hands-on, manual therapy as part of a patient’s care plan. Manual therapy has a place in occupational therapy treatment plans as manual techniques can enhance functional range of motion and manage pain for improved participation in daily tasks.
Final Thoughts
Understanding and correctly using CPT Code 97140 can enhance the overall efficiency of your practice. By employing the right billing practices and ensuring thorough documentation, you can save time and resources, and focus more on providing the best care to your patients.