Codapedia is now a division of Find-A-Code

AMA Issues new CMT Information

January 14th, 2019 - Wyn Staheli, Director of Research
0 Votes - Sign in to vote or comment.

As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion on what services are included in the pre- and intra-service work involved when performing CMT (98940-98943). While this new FAQ does not necessarily state that you cannot report E/M with CMT, it is less vague than guidance from previous CPT Assistant issues (e.g., December 2007 page 16c, January 1997 pages 7-8) and does offers some additional information/clarification.

To more fully examine the problem, we begin with the official CPT Guidelines as found in the CPT codebook (emphasis added):

The chiropractic manipulative treatment codes include a pre-manipulation patient assessment. Additional evaluation and management services … may be reported separately using modifier 25 if the patient's condition requires a significant, separately identifiable E/M service above and beyond the usual preservice and postservice work associated with the procedure. The E/M service may be caused or prompted by the same symptoms or condition for which the CMT service was provided. As such, different diagnoses are not required for the reporting of the CMT and E/M service on the same date.

From this statement, the following seem to be the main points of disagreement between payers and providers:

  1. What is considered the “usual” pre-, intra- and postservice work?
  2. Does the patient condition require a significant, separate E/M service?
  3. What is considered significant and separately identifiable?

To evaluate some of these points, note the following information from the new FAQ in the boxes below which are direct quotes (bullet points added by ChiroCode for clarity):

Preservice work includes:

  • physician review of the patient’s records to establish a treatment plan and to familiarize himself or herself with the previous treatment;
  • to conceptualize the range of potential manipulative treatments that may be performed in the appropriate number of body regions for the current date of service;
  • to explain the potential procedures to the patient and obtain verbal consent; and
  • to answer any additional questions, comments, and/or concerns.

- November 2018, CPT Assistant, page 12

 Intraservice work includes a pre-manipulation patient assessment which includes the following:

  • an assessment of the patient’s pain level;
  • evaluation of interval changes in objective signs; and
  • evaluation of functional changes that may include identifying asymmetry, assessing segmental mobility, and evaluating changes in tissue and tone in the affected regions.

- November 2018, CPT Assistant, page 12

The following quotes from that FAQ regarding intra-service work are very important:

  • A treatment procedure that best fits the patient’s condition is finalized that day.
  • This intraservice work is inherently included as part of the CMT service and would not be reported separately.

Alert: It would NOT be appropriate to do an E/M service on one day and then have them come back the following day for the adjustment just so you can bill the E/M separately.

ChiroCode has long stated that E/M codes could be appropriate to report CMT and E/M as long as the requirements for a separate E/M visit are met. The CPT code book and this new guidance support our stance and make it clear that there are some valid reasons to support the medical necessity of both services. However, it should be noted that the AMA has not come out with a statement saying exactly what, in their opinion, constitutes a “significant and separately identifiable” encounter. So that still leaves it open for interpretation. As such, payers will likely continue to have their own standards.

The 2019 ChiroCode DeskBook includes some examples (e.g., exacerbation, aggravation, re-injury) in the “E/M for Chiropractic” section which begins on page 345. However, as noted above, payers may have their own policies regarding when it would be appropriate to report E/M services on the same day as CMT.


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)

How to Report Imaging (X-Rays) of the Thumb
March 18th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
Revised ABN Requirements Still Fuzzy
March 18th, 2019 - Wyn Staheli, Director of Research
Although it has been quite some time since ChiroCode published an article about the revised instructions for non-participating providers who use the ABN, there are still some outstanding questions about this change. So far, Medicare has not provided additional guidance about this question despite requests by us for clarification. Medicare now requires non-participating providers to include the ...
Voluntary Repayments
March 8th, 2019 - Namas
Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false ...
Q/A: Can you Help me Understand the New Medicare Insurance Cards?
March 7th, 2019 - Wyn Staheli, Director of Research
As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.
Date of Service Reporting for Radiology Services
March 7th, 2019 - Wyn Staheli, Director of Research
Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.
Spotlight: GLOBAL Periods
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal post- operative care are bundled into the global surgery fee. Global surgery is not restricted to hospital...
Spotlight: Click-A-Dex Tool
March 4th, 2019 - Brittney Murdock, QCC, CMCS, CPC
Another popular search tool is our index system Click-A-Dex Tool. Click-A-Dex is formatted like the indexing in a code book, this is a quick and easy tool for an enhanced index search. Simply start typing in the desired search, once you type in your desired condition, the results will show...

About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 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