resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
February, 2006, Vol. 06, Issue 02
Coding for Insurance Billing and Medicare Issues
By Vivian Madison-Mahoney, LMT
From the phone calls and e-mails I've received from massage therapists across the country and a recent survey taken by AMTA, it's evident there are a variety of CPT Codes being used by massage therapists for billing insurance.Many of those codes used include deleted codes, codes not in our scope of practice, codes that raise red flags with insurers for a variety of reasons and correct codes used in conjunction with incorrect codes.
Coding and billing requirements and opportunities have changed over the years. When I began billing insurance in late 1984, I billed by using code 97139, (an unspecified procedure code). I used the term, "soft tissue manipulation," eliminating the words "massage or massage therapy." This worked fine for several years until my first Blue Cross case.
It was an eye opener when Blue Cross only reimbursed $12 for a full hour session. After continued research and questions, I soon learned about the fifteen minute increment billing requirements by some insurers. In my desire to find ways to get massage therapists in the system so to speak, I began to do more research and began practicing with other codes. It was then I learned that Blue Cross would only reimburse for CPT Code 97124 (massage). Billing the way Blue Cross required I was then reimbursed $48 for the full hour. Getting an increase from $12 to $48 was an exciting time!
Workers' compensation in Florida, at that time (as with many states yet today), was way behind the times when it came to coding, so I had to bill differently with them using codes not used with any other carrier. Over the years, my office expanded the use of codes as we were reimbursed for them. However, as time went on and the reimbursement amounts began to increase, we began to reduce the number of codes we experimented with to simplify things.
Because I am a provider of CEU'S for insurance billing seminars and home study courses, I became a lot more conservative in order to protect you, who now bill insurance companies. It's now to the point where possibly the only available and necessary procedure code(s) are 97124 (massage) for basic Swedish massage, and 97140 (Manual Therapy Techniques), because it encompasses myofascial release, manual traction and manual lymphatic drainage and because reimbursement now is at a fairer rate in most cases.
There are many "techniques" of massage, but there are no codes to represent these "techniques." We must use those procedure codes available to us that are within our scope of practice. Of course, there always are those codes for modalities which might be used if within a therapists scope of practice, such as whirlpool, infrared, contrast baths, electrical stimulation, hydrotherapy, paraffin baths, etc. Be sure you know and stay within the scope of practice for the state you practice in.
Documentation is the key to getting paid for the time spent and the codes used. Following the doctor's prescriptions, billing for the same procedure or modality that is on the prescription and documenting exactly that, are the keys to being better paid without delays, denials or reductions, and only accepting cases that will reimburse a massage therapist. Not all types of cases are reimbursable to a massage therapist.
As time goes on, I am sure coding changes or definitions will work more in our favor but until it does, let's use common sense and don't try to go overboard as it only raises red flags with insurance companies that could set us back many years. Stick to your scope of practice and with what is written on the prescription. Make sure your progress (SOAP) notes reflect what the prescription calls for and that your bills reflect both the prescription orders and your documentation.
There is a company called Alternative Link/ABC Coding working on an entirely different coding system for each alternative provider. These codes ultimately would incorporate each technique used by a massage therapist or other alternative care providers. However, until these codes can be used by all therapists and accepted by all insurers, I will be keeping in close contact with them. I will inform you of any changes or abilities to use this coding system when it becomes available. For more information on this coding system please contact Connie Koshewa at: .
The Medicare Issue
For more information on the coalition to Preserve Patient Access to Physical Medicine and Rehabilitation, please contact me if you did not receive this information on my recent "Massage Insurance Updates" e-mail. If you are not on that list but want to be, please e-mail your request to me at .
Click here for more information about Vivian Madison-Mahoney, LMT.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.