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Personal Injury CPT Codes for massage

Not sure if anyone can help me out with this but I thought I'd put it out there just to see.

I have a couple of auto accident cases I'm working with. Their insurance has always paid for massage so I'm not so worried about getting paid but I want to make sure that I'm coding things right.

If I use 97124 - for a theraputic procedure then would deep tissue massage fall under that or under the manual therapy of 97140? This is what is so confusing about this all. I am using deep tissue massage and I want to make sure I am using the proper and correct coding so I'm not committing insurance fraud.

Thanks for your help.
Missy

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Permalink Reply by Jody C. Hutchinson on September 10, 2010 at 8:27am

Melissa,
I'm not sure what state you're in but here's some general info that might help.

Use CPT 97140-manual therapy and bill for 4 units@15 min. each for a one hour treatment. I find that using this code is better than 97142-massage, I try not to use the word "massage" in my notes or correspondence. I think that massage doesn't cover deep tissue, MFR, NMT, etc. Make sure that your documentation and SOAP notes are short and clear and that you only treat the prescribed areas. Best of luck.
Jody

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Permalink Reply by Angela Yates on September 15, 2010 at 2:46pm

I use these:
4 Units @ $25 97140 - Massage
1 uinit @ $15 97112 – ROM
2 units @ $25 97250 - Myofascial Release
2 units @ $25 97530 - Lymph Drainage
1 uinit @ $15 97010 – Ice/Heat

Units:
8 minutes to 22 minutes is billed as 1 unit
23 minutes to 37 minutes is billed for 2 units
38 minutes to 52 minutes is billed for 3 units
53 minutes to 74 minutes is billed for 4 units

Make sure you have a Diagnosis Codes on your billing such as these that I have used in the past:
723.1 Cervicalgia
728.9 Unspecified Disorder of Muscle, Ligament, and Fascia
719.41 Pain in Joint, Shoulder Region
729.81 Swelling of limb
782.2 Localized superficial swelling

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Permalink Reply by Melissa Sivigny on September 15, 2010 at 7:54pm

Thanks to both of you for your response! It helps out so much. This insurance stuff is all new to me. Their (the clients) insurance company is paying for the 97142 so I think I'm going to keep using that one verses changing it to much. Its just that I'm using a lot of deep tissue work with them. I will be using the diagnosis codes. I have the ones the chiropractor issued. I'm working with him on the treatment plan. I hate to change things so much that I don't get paid for it. I will be using some NMR and PNF stretching and also exercises eventually so I know those codes are different. But I was planning on charging more for those when I get into those. Hopefully I will do it all the right way.

Have either of you taking a course on insurance billing?

Thanks again.

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Permalink Reply by Lorinda Snoddy on September 15, 2010 at 9:17pm

I have been filing insurance for about 5 years. Deep tissue massage can fall under both codes. It is a theraputic procedure and it is a manual therapy. Just keep good notes in case it goes to trial because your records could be requested for court or by the insurance company.

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Permalink Reply by Lorinda Snoddy on September 15, 2010 at 9:40pm

I have taken www.LMTsuccessgroup.com insurance billing and medical massage class. I really liked it.

Just make sure to follow the prescription if you have one. The arm and legs count as 1 unit, the neck and shoulders count as 1 unit and the back counts as 1 unit.

If the client is having a lot of swelling, you might want to look at the www.EasePainNaturally.com site. There are a lot of natural products to help with pain and swelling.

Melissa Hoffman said:

Thanks to both of you for your response! It helps out so much. This insurance stuff is all new to me. Their (the clients) insurance company is paying for the 97142 so I think I'm going to keep using that one verses changing it to much. Its just that I'm using a lot of deep tissue work with them. I will be using the diagnosis codes. I have the ones the chiropractor issued. I'm working with him on the treatment plan. I hate to change things so much that I don't get paid for it. I will be using some NMR and PNF stretching and also exercises eventually so I know those codes are different. But I was planning on charging more for those when I get into those. Hopefully I will do it all the right way.

Have either of you taking a course on insurance billing?

Thanks again.

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Permalink Reply by Jody C. Hutchinson on September 16, 2010 at 8:44am

Melissa,
I've taken several courses on insurance billing in the last 10 years; two at a Chiropractic convention, one from TMMO, have read several books, and asked thousands of questions to whomever would answer. The best way to get good at it is to do. Just like exercise.
I'm a little bent about the time thing, charging 1 unit for less than 15 minutes is a grey area that is exploited by many practitioners to make more money. Be careful.
Jh

Melissa Hoffman said:

Thanks to both of you for your response! It helps out so much. This insurance stuff is all new to me. Their (the clients) insurance company is paying for the 97142 so I think I'm going to kHave either of you taking a course on insurance billing?

Thanks again.