Chiropractic Coding & Compliance Alert

Question: What modifier would I report for a patient who had a CMT (98940-98943) for three vertebrae? Is modifier 51 correct?

Rhode Island Subscriber

Answer: Modifier 51 (Multiple procedures) is not appropriate for these codes as they already have a multiplier incorporated into their descriptors. 

Code 98940 (Chiropractic manipulative treatment [CMT]; spinal, 1-2 regions) is for one to two regions and then the number of regions increases from there. You should only use one code as the code descriptors illustrate: 98941 (… 3-4 regions), 98942 (… 5 regions), and 98943 (… extraspinal, 1 or more regions).You shouldn’t use a modifier.

Here’s why: CMT codes are based on the regions treated, not the number of vertebrae. So if three vertebrae in two regions are treated, 98940 is the correct code and you don’t need a modifier.

Another tip: When reporting CMT codes, remember to only report the code once when a physician performs manipulation on more than one vertebra of the same spinal region.

 

 

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