Forum - Questions & Answers

Jan 22nd, 2020 - phil.jen

CPT 99213 w/ 98941, 97110 or 97140 for Aetna

Does anyone have any suggestions on billing 99213 w/ 98941, 97110 or 97140? All office visits get denied, stating that they can't be done on the same day as manipulation or therapy. So, we had a patient willing to come in one day for the office visit & then came in the next business day (two days later) for manipulation and therapy. 99213 was once again denied, stating it was not medically necessary.

Someone, please help!

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Jan 22nd, 2020 - ChrisW   170  1 

re: CPT 99213 w/ 98941, 97110 or 97140 for Aetna

98940-98943 manipulation codes cover three components for this service which are all bundled together within the code description

1) Pre-assessment of the patient, which means you are going to examine the patient, palpate the patient, and possibly perform an orthopedic test.

2) The Chiropractic Manipulative Treatment (CMT).

3) Post-assessment, where you evaluate the results of the treatment.

Only in certain cases where ‚Äúsignificant, separately and identifiable‚ÄĚ E/M services are performed in addition to the three steps identified by the 9894x code set should you consider adding an additional E/M code, and then you would need to append a -25 modifier to the appropriate E/M code selected.

I would also suggest viewing the policy and exclusions of the plan, The following can be found on Findacode.com under Commercial payer policies Aetna, policy number: 0107. Aetna's policy states, "if no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary."

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