Should ROM Testing be Reported with Evaluation and Management Services?

January 9th, 2018 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
Categories:   Evaluation & Management (E/M)   Billing  
0 Votes - Sign in to vote or comment.

We recently received an email from a reader asking whether or not range of motion (ROM) testing (95851-95852) using a duel computerized inclinometer with a separate report when done at the same time as an Evaluation and Management (E/M) services, could be billed if reported with modifier 59 to override the NCCI edit. The reader referred to the patient's condition indicating the need for “more definitive and quantifiable data” and referred to the specific ROM Assessment guides set by the AMA.

Although it may seem justifiable and even medically necessary to perform these services simultaneously, CMS has determined they are incidental to each other. According to the National Correct Coding Initiative (NCCI) edits, when range of motion (ROM) testing is performed (95851-95852) at the same time as an Evaluation and Management (E/M) service it will be denied as incidental (or an expected part of) the physical examination portion of the EM service. In other words, the physical examination portion of the E/M service should include ROM testing, if performed so they will not pay for it separately. Medicare addresses exactly this situation in the Medicare Benefit Policy Manual, Chapter 15, Section 240.1.2:

A subluxation may be demonstrated by….Physical Examination Evaluation of musculoskeletal/nervous system to identify:

  • Pain/tenderness evaluated in terms of location, quality, and intensity;
  • Asymmetry/misalignment identified on a sectional or segmental level;
  • Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); and
  • Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament.

To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under “physical examination” are required, one of which must be asymmetry/misalignment or range of motion abnormality."

Additionally, according to the NCCI edits ROM testing can only be reported with certain critical care E/M services but these would not likely be performed by Chiropractors in the hospital setting.

So when can you be reimbursed for reporting ROM testing?

A provider, properly educated, licensed, and allowed under state practicing laws who performs ROM testing (95851 - 95852) as a separate and independent service could be eligible for reimbursement, as long as a separate written report identifying any findings is included in the medical record.

Many physical therapists routinely perform both ROM testing (95852-95852) and manual muscle testing (MMT) (95831 - 95834) as a routine part of 97750. In this situation, ROM and MMT would not be separately billable, but rather would be billed as part of 97750 instead. 

A caveat about this code, that many forget is the description for 95851 is that it is range of motion testing per extremity (each extremity), meaning for each extremity you do, you can bill one (1) unit of service. However, each extremity has the ability to check range of motion for each joint pertaining to that extremity and many times only one is performed. Documentation must clearly identify the complete ROM testing for each extremity for which a unit of service is reported. 

The specialized software for ROM testing is useful for many providers; however, the circumstances surrounding the reason for the test and the other services performed at the same encounter will completely determine whether or not these services are reimbursable or considered incidental to the other services provided. To ensure proper reporting, always check your codes using the NCCI Validator Tool, available through certain Find-A-Code subscriptions.

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

A Step by Step Guide to Medical Billing
August 20th, 2019 - Christine Taxin
The next 4 weeks we will be providing you with a step by step guide to why medical billing is now part of our Dental future. Dental surgery is performed to treat various conditions of the teeth, jaws, and gums. Surgical procedures that dentists perform include dental implants, treatment for temporomandibular ...
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
August 20th, 2019 - Aimee Wilcox
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
Understanding Payment Indicators
August 19th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Understanding how payment works with Medicare payment indicators and the impact a modifier has on payment is vital to pricing. Even if you are not billing Medicare, most carriers follow Medicare's policies for participating and non-participating rules.  Here is an article from Regence on their policy statement, describing the rules ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
Healthcare Common Procedure Coding System (HCPCS)
August 13th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?
August 13th, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
Question: We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do? Answer: Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019 - Wyn Staheli, Director of Research
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association