Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 594
Office Systems 51 OS

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues I bring are small, yet each issue is just that… an issue. If you take care of the small issues, then you will be able to build and focus on the larger issues… a larger, more profitable practice along with more family time. 

“Billing Multiple Modalities”

I just received a question on billing multiple modalities and treatments simultaneously. In other words, can I apply 2 therapies/modalities/treatments at one time to do 2 procedures at once that have timed requirements and consider billing both for the same “clock time.” This brings up another issue… you MUST use clock time and not simply 12 minutes (as an example), you need to document 9:00am-9:12am for electric stimulation or any other time required procedure.
 
 
The following are Medicare guidelines that most every carrier in the nation uses even if they are NOT Medicare. This was published in 2009 and if anyone has a newer set of Federal guidelines that is different please send it to me. AND… Just because it is pointed at PT’s and OT’s, for similar services the similar rules apply. 

 
 
Use the reference for a more complete understanding of the entire process. 

 
1. Billing - CPT Codes: Not Permitted In the same 15-minute (or other) time period, a therapist cannot bill any of the following pairs of CPT codes for outpatient therapy services provided to the same, or to different patients. Examples include: 

a. Any two CPT codes for "therapeutic procedures" requiring direct one-on-one patient contact (CPT codes 97110-97542); 

b. Any two CPT codes for modalities requiring "constant attendance" and direct one-on-one patient contact (CPT codes 97032 - 97039); 

c. Any two CPT codes requiring either constant attendance or direct one-on-one patient contact - as described in (a) and (b) above -- (CPT codes 97032- 97542).

For example: any CPT code for a therapeutic procedure (eg. 97116-gait training) with any attended modality CPT code (eg. 97035-ultrasound); 

d. Any CPT code for therapeutic procedures requiring direct one-on-one patient contact (CPT codes 97110 - 97542) with the group therapy CPT code (97150) 
requiring constant attendance. For example: group therapy (97150) with neuromuscular reeducation (97112); 

e. Any CPT code for modalities requiring constant attendance (CPT codes 97032 - 97039) with the group therapy CPT code (97150). For example: group therapy (97150) with ultrasound (97035); 

f. Any untimed evaluation or reevaluation code (CPT codes 97001-97004) with any other timed or untimed CPT codes, including constant attendance modalities (CPT codes 97032 - 97039), therapeutic procedures (CPT codes 97110-97542) and group therapy (CPT code 97150)

 
See reference numbers 4. and 5. above. 

 
2. Billing - CPT Codes: Permitted in the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where "supervised modalities" are defined by CPT as untimed and unattended -- not requiring the presence of the therapist (CPT codes 97010 - 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist. See reference numbers 4. and 5. above. 


 
 
Respectfully,



Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

Academy of Chiropractic
US Chiropractic Directory
631-786-4253
PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.