Spinal ManipulationUnderstanding the differences between CPT codes 97124 and 97140.

By Marty Kotlar, DC, CHCC, CBCS

Q: I’m not sure how to differentiate between CPT codes 97124 and 97140. They seem very similar to me. Can you explain the difference and provide some practical examples?

A: CPT code 97124 is for massage therapy. Massage therapy includes effleurage (circular movement), petrissage (lifting, squeezing), and/or tapotement (stroking, compression, percussion).

Massage therapy is a therapeutic procedure on one or more areas, each for 15 minutes. Massage therapy could be used as a preparatory procedure on the same day as a therapeutic procedure to restore muscle function, decrease stiffness, reduce edema, improve joint motion, or for relief of muscle spasms.

It should be related to other therapeutic procedures within the overall plan of treatment.

CPT code 97140, on the other hand, is for manual therapy techniques. Manual therapy techniques include soft tissue and joint mobilization, manipulation, manual lymphatic drainage, manual traction, trigger point therapy (non-injectable), and myofascial release.

Manual therapy techniques are used to treat restricted motion of soft tissues in the extremities, neck, and trunk. These are used in an active and/or passive fashion to help effect changes in the soft tissues, articular structures, and neural or vascular systems.

For example: Facilitation of fluid exchange, restoration of movement in acutely edematous muscles, or stretching of shortened connective tissue.

Manual therapy is used when a loss of motor ability impedes function. Manual therapy is also considered a therapeutic procedure, on one or more areas and each for 15 minutes.

Another difference between 97124 and 97140 is the intention of the therapy. If you are performing therapeutic massage in order to increase circulation and promote tissue relaxation to the muscles, and the treatment is based on or consists of a basic relaxation massage, you should use 97124.

If, however, your intention is to increase pain- free range of motion and facilitate a return to functional activities, you should use 97140.

The documentation for both services should show objective loss of joint motion, strength, or mobility, and must be part of an active treatment plan directed at a specific outcome.

Important notice: The National Correct Coding Initiative (NCCI) edits created by the Centers for Medicare and Medicaid Services (CMS) require that manual therapy techniques be performed in a separate anatomic site than the chiropractic adjustments in order to be reimbursed.

Therefore, if you do this, attach the 59 modifier to 97140 in order to indicate that it is a distinct procedure and is being performed at a different anatomic region than the chiropractic adjustments.

Documentation of therapeutic procedures: Modalities (e.g., mechanical traction or ultrasound) are generally coded and billed based on the device that is used.

Therapeutic procedures are generally coded and billed on the basis of the intended outcome, not on a device or piece of equipment.

When billing and coding for therapeutic procedures, document the intended clinical outcome, as well as how the procedure is performed.

The relationship to a functional activity is important to document in the treatment plan.

For example: Increase flexibility of the quadratus lumborum muscles, while activating and stretching the hamstring muscles, to help improve the patient’s capacity for walking and standing.

KotlarMarty Kotlar, DC, CHCC, CBCS, is the president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, drkotlar@targetcoding.com, or through www.TargetCoding.com.