by Dr. Terry Peterson, D.C.

Q: How do I code for the use of the Impulse Adjusting Instrument?

A: There is still a lot of confusion as to how to bill an Impulse treatment and the answer is that it is “Manual Manipulation” billed as any other manipulation (CMT) 98940, 98941. 98942 or 98943. The use of the Impulse adjusting instrument does not qualify for any additional payment or use of any other CPT code for billing.

To further clarify, chiropractic adjustments with the Impulse family of adjusting instruments qualify as a Medicare “covered” 98940,98941 and 98942 CMT codes as described in CMS manual:30.5 Chiropractor’s Services (Rev. 23, Issued: 100804. Effective: 100104, implementation: 100404) B32020.26 ): “In addition, in performing manual manipulation of the spine, some chiropractors use manual devices that are handheld with the thrust of the force of the device being controlled manually. While such manual manipulation may be covered, there is no separate payment permitted for use of this device.”

Q: Can I bill for manual treatment methods in addition to spinal manipulation? Could Impulse be billed as manual methods

A: Doctors who want to bill the code 97140 manual methods in addition to a spinal manipulation need to understand the limitations to its use. First, 97140 must be used in a different area than the area of the spinal manipulation was administered.

In other words, if you were to perform a CMT service on the cervical spine (90940, 12 Spinal Regions) the only way that you could justify billing manual treatment methods would be to perform the service at a region outside of the CMT. Second, the code 97140 for manual methods is a timed 15 minute code.

While there may be instances where you choose to perform a chiropractic adjustment (CMT) to one region of the spine, and manual methods to another, you have to perform the manual methods procedure for a 15 minute time frame, or use a modifier to indicate the lesser time frame for which you did administer it.

Clearly, we do not advise or advocate that chiropractors bill the use the Impulse instrument as manual methods.Q: Can I bill 96150 for using outcome measures in my practice?A: Many doctors use outcome assessment measures in their practice and a common question that arises relates to the ability to bill separately for outcome measures such as Neck disability
index, Oswestry low back index, Rolland Morris low back index, etc. Based upon information provided to us by primary coding experts, in the past we thought that the 91650 code was appropriate for billing outcome assessment measures.

However it has been brought to our attention recently that there has been confusion as to the actual intent of this code and now based upon the most recent advice from the ACA and other legal sources, we recommend using G8539 (as used in PQRI reporting) or E/M codes as recommended by the ACA’s coding committee for billing outcome assessment.Below is the official response from the experts on this issue:The use of the CPT® code 96150; Health and behavior assessment (eg, health focused clinical interview,behavioral observations, psychophysiological monitoring, health oriented questionnaires), each 15
minutes face-to-face with the patient; initial assessment, is restricted to non-physicians (psychologists, nurses, LCSWs, etc.) and should not be used for reporting these applications.

Health and behavioral questionnaires and outcome assessments are typically filled out by the patient and scored by the provider to evaluate patient improvement, and in most cases, these applications would be included as part of the evaluation and management (E/M) service rendered on a given visit.