August 10th, 2015
Doctors who are certified in Manipulation Under Anesthesia (MUA) wonder how to code when performing similar type stretching/overpressure procedures in the office setting, rather than in a hospital or ambulatory service center.
Subjective and Objective Findings
MUAs are typically performed as outpatient or inpatient hospital procedures. However there are times that the MUA certified chiropractor desires to do a similar type stretching procedures in the office, but not while the patient is under anesthesia. The MUA type procedure involves stretching muscles in the cervical, lower back and lower extremities.
Two peer review consultants (claim reviewers) who are familiar with and certified in MUA training had these comments on this issue:
“The pre-manipulation stretching/overpressure type moves would typically be a part of the CMT service done in the office; and if it was billed separately and under another code, I would look at it very closely.” And,
“I, too, use them for the purpose of tissue elongation in a clinical setting. I consider the treatment a form of mobilization and a component of the CMT service code. It would be inappropriate to bill 97112 or 97530. Perhaps it could be appropriate to bill 97140 (soft tissue mobilization) in addition to the CMT code if both manipulation and tissue elongation were performed and documented.”
Typically, from a proper coding perspective, when such MUA stretching type procedures are performed in the office they are a component of the CMT service. Because of the CPT requirement to code to the most accurate description, neither the 97112 nor 97530 seem to qualify. 97140, in addition to the CMT code, could be appropriate.
If CMT is not performed, the stretching therapy could be an integral component of a 97112 service. The 97530 code is for “dynamic” activities, and not “static,” which is typical in MUA protocols. Only when the stretching is a component of such “dynamic” services could 97530 be used, if and when the focus is on functional improvement. Time is a key factor in each of these therapeutic procedure codes (97112, 97530 and 97140). Each 15 minutes equals one unit of service. The use of 97112 and 97530 for stretching is stretching the coding rules, and flies directly into the radar screens.
MUA doctors need to critically re-evaluate their in-office MUA type stretching procedures. If the mobilization (stretching) techniques are significant and distinctly different from the routine CMT care, it could be appropriate to use 97140-59. Document the technique, location and time in the chart. Remember that 97140 is for each 15 minutes.