The CPT Codes to Use When Billing Insurance by Ed Denning, LM.T. jo on Current Procedural Terminology (CPT) codes are used to report procedures to U.S. medical specialists and insurance companies. Descriptions of the codes can be found in The AMA Current Procedural Terminology Manual, published annuclly by the American Medical Association. vices is neither dangerous nor difficult. Ic requires the same sorts of skills—thought, learning and arcention to 2 few details—you used to become a massage therapist, Experience alone has no bearing on code usage; however, if in your licensure or training description there is spec fic mention ofa particulae skill using the recognized medical terminology, then you should be considered qual- ified to do the applicable procedure ‘These are the CPT codes which ought to be on your cur- rent list of acceptable codes: 97010: 97124 orm cer ees moe ‘sage, Including effleurage, petrissage and/or tapotement. U sing medical codes for billing massage therapy ser- Application of « modality to one or more areas; hot or cold packs. 97001 and 97002 refer to the evaluation and re-evalua- tion processes by which the therapist provides an overall treatment plan separate and distinct (in writing) from the treatment process itself. Note that the American Physical ‘Therapy Association takes strong exception to the inclusion of these two codes in the list of codes usable by massage therapists. In some states the words “physical therapy” by law may only be used by physical therapists. Before using cither of these codes it is recommended that you contact your state's physical therapy association co find out if yours isa restricted stace. OB Ed Denning is coordinator of the mastage therapy program at Stark State Callege of Technology in Canton, Ohio. He is a past president of the Ohio State Masstherapy Asociation, and isa member of the Ohio Masiage School: Council and of the Obio State Medical Board Massage Therapy Advisory Com- mittee. He it aio the principal author of The Medical Code Therape © more ar ic procedure, one or each 15 minutes; unlisted therapeutic procedure (specify). 97140: Manual therapy technique: ‘2 such as mobilization/manipu- lation, manual lymphatic drainage, manual traction; ‘one or more regions, each 15 minutes. ‘Two additional codes may be on your list, depending on where you live: 97001: and 97002: Physical therapy evaluation; Physical therapy re-evaluation. + Boing pai fora cod BEE RET BLES valid massage therapy code. Those who epprove payment may know nothing about the selection and use of CPT codes for rassage therepy. Getting pai for invalid codes wil esut in legal ection by government agencies and being dropped from provider lists by health insurance compe- ries, Agencies may go as far back a8 seven years t0 demand refunds. ++ itis the therapist's responsibilty to select and use the correct CPT code. Your code list should be updated year- ly (the new code manuals are published in October. * Keep professional records. If you are going to do billing, organize your office in such @ manner that your records ‘support each other. The telephone log which is kept with ‘each call is a legal record, It ought to be abie to show that the call resulted in an appointment in your appoint- ‘ment book. The clinical records are dated showing that the appointment book matches the dated clinical record, ‘The receipt has on it the CPT and ICD 9 numbers which describe the activity recorded in the clinical record. SeeBUSINESS PRACTICES & PROFESSIONAL ETHICS BUS-5 97112 pays $20 for neuromuscular reeducation 97110 pays $20 for therapeutic exercise 97530 pays $40 for kinesiology 97999 pays § for hydrotherapy hot or cold pack, charge $10 ICDM= diagnosis from doctor's office REMEMBER: Workman's comp always pays if you fill out the forms correctly! Be able to explain what you do. Checklist for working on insurance patient (get these BEFORE you work on them): * signed assignment form to be paid directly by insurance company. * doctor's Rx + patient progress report + ledger (statement) to keep track of payments & treatments SEE HANDOUTS: Forms Required for Personal Injury Claims Doctor's Prescription Form Client Information Assignment of Benefits Authorization to Pay Provider Patient's Progress Record ‘Statement Form TWCC 67 Health Insurance Claim Form Peacenery One-Write Bookkeeping System busts wm FBUS-5