resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
November, 2004, Vol. 04, Issue 11
By Ed Denning, MEd, LMT
CPT means Current Procedural Terminology. Massage therapists may not use any CPT codes from any area of the American Medical Association (AMA) CPT code manual outside of the physical medicine and rehabilitation pages.The CPT codes massage therapists can use without question are: 97010 - hot and cold packs; 97124 - massage; and 97140 - manual therapy. In my opinion, any other code is questionable and should be avoided unless the user has certifications that have specified the CPT code that represents the procedure they are training you to use.
Codes 97124 and 97140 should not be used to bill for activities within the same session. Most of us could not distinguish when our therapist transitioned between the techniques used in 97124 to the techniques used in 97140 and vice versa. 97001 and 97002 are for physical therapy evaluation; these codes are for physical therapists and should not be used by massage therapists. Their use implies that the user is a physical therapist. 97112 is not the code for neuromuscular therapy; use 97140 instead.
The codes may change from year to year. If you are going to be a user, you will need a yearly updating service to be sure you are current on the CPT codes available for your use.
Distinct Procedural Service
CPT Code Modifier - 59. The purpose of CPT code modifiers is to clarify the activity and intent of the therapist. An example would be modifier -59. This modifier is used to report Distinct Procedural Service. The following example will help clarify its proper use:
A client schedules an appointment for therapy of carpal tunnel symptoms in both wrists and hands. The therapist has confirmed with the insurance company that it will pay for their services. An hour session is scheduled. The work on the right arm and hand turns out to be very slow and detailed, requiring much more time than planned. The session ends with no work having been done on the left arm and hand. An appointment has canceled that same afternoon and the client is willing to return for work on the left side. This would be a new, separate appointment. The work on this arm is completed in an hour with good results.
If the therapist bills 97140 for both appointments with the same ICD code, it will look like double billing. To explain the apparent discrepancy the therapist would code the first session as 97140 and the second session with 97140-59.
Note that the use of the -59 modifier identifies two procedures of similar nature performed on the same individual within a single day or a few days. Using -59 modifier may raise flags with an insurance company and delay payment.
CPT Code Modifier - 52. CPT modifier -52 is for reduced services. Like -59, it is used to help explain what has taken place with one client. Its purpose is to identify and clarify the activities of the therapist. An example will help make its use clear:
The fee for the reduced service unit would be reduced also.
This code is being misused to justify differences between the fees for cash clients and insurance clients. That misuse is the result of a misunderstanding regarding the intent and purpose of the modifier. It is used to explain the time differential between two units of therapy, one of which is shorter than the other. In this case: one client, one two-unit session. The -52 modifier has nothing to do with the difference between the costs incurred with a cash client compared to an insurance client.
Unusual Procedural Services
CPT Code Modifier - 22. This code does not apply to any of the CPT codes massage therapists can use. It is intended for use with diagnostic and evaluation CPT codes, or very specific medical procedure codes. It is designed to report when the usual time period for that procedure is extended due to extenuating circumstances. This modifier will require a report to justify the additional time. Like modifiers -59 and -52, its application is to a single client and a single session.
Using modifiers to justify increased fees to insurance companies is a misuse of those codes and damages our relationships with the medical community and insurance companies. The use of CPT modifiers by massage therapists is seldom appropriate or necessary. The vast majority of us would keep to a schedule of full units, in which the use of modifiers would be for very unusual circumstances only.
Who do you charge the higher fee: A teacher, business executive, factory worker, or sales clerk?
The answer, of course, is that they all should be charged the same fee for the same service. Can you make exceptions? Sure! If I want to give a discount to teachers, I can. All fees charged need to be in a published list available to all clients. If all clients are to be treated the same, what about insurance clients? There are additional expenses involved in dealing with insurance. Unfortunately, there are no administrative or office codes available to massage therapists which we can use to pass on those costs.
A legitimate manner in which to charge a higher fee for your therapeutic services is to have a fee schedule posted that clearly indicates that therapeutic work is billed at a higher rate due to the increased skill level and attention to business details (paperwork). In that case, both the prescribed and non-prescribed therapeutic work would be billed at the same rate. Non-prescribed/non-therapeutic work could have a lower fee.
The difference between the costs of therapeutic-prescribed massage and non-therapeutic massage should not be 100 percent. We are not physicians. A 20 percent difference would be an acceptable and professional differential. The codes that will more accurately represent our services will be forthcoming; we need to practice restraint and patience for now.
An Insurance Company's Response to Coding Abuse
A major insurance carrier in Colorado has restricted all claims by massage therapists to CPT code 97124 and has set a maximum fee that it will pay. The company did this in response to the use of 95 different CPT codes by Colorado massage therapists, for which the therapists charged fees of up to $350 per hour.
Those who abused the system have been punished; however, every massage therapist who must work with that company has also been punished. Some of our colleagues abuse the medical payment system for the short-term gain. In the long term, they damage the massage industry and do harm to the majority of massage therapists who do not allow personal gain to interfere with ethical judgment.
I encourage all massage therapists to join a professional association and to lobby the leadership of their association to take action to educate its members about the legal and ethical responsibilities of coding and billing. It is time for the associations to stand up and protect their membership from the abusive billing strategies being taught at seminars all across the U.S.
Ed Denning is a licensed massage therapist in Ohio. He is coordinator of the massage therapy program at Stark State College of Technology, and also serves on the Massage Therapy Advisory Committee of the Ohio State Medical Board.
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