A chiropractor recently contacted ChiroCode and told us that a payer claims that 97140 manual therapy and 97112 neuromuscular re-education are not separately billable from a chiropractic manipulative therapy (CMT), such as 98940.  While Medicare's Correct Coding Initiative does require the 59 modifier to be added to these codes when billed with a CMT, nothing there prohibits them from being billed together.  To clearly document that the CMT is separate from the 97140 and 97112, the record could indicate a distinct diagnosis that relates to the type of service provided.  For example:

• 98940 might be justified by M99.01 segmental and somatic dysfunction, cervical region. 
• 97140 might be justified by M79.1 Myalgia, myofascial pain syndrome. 
• 97112 might be justified by M62.81 Muscle weakness (generalized), R42 vertigo NOS, or R26.0 ataxic gait.

The diagnosis pointers should clearly link to a distinct procedure rather than all of them.  To help establish medical necessity for each procedure the care plan should outline specific and measurable goals for each service.  For example:

• 98940:  Show favorable changes to PART exam, such as reduced pain and increased ROM by a certain amount by a certain date.
• 97140:  Reduce quantity/frequency/locations/severity of trigger points by a certain amount by a certain date.
• 97112:  Improve muscle strength from 3/5 to 4/5 by a certain date.  Or restore gait to normal by a certain date.

These goals are clearly separate and distinct.  And they are very specific and measurable.  Functional progress should then be demonstrated at each re-exam by achieving the goals, or remarking about lack of progress if applicable.  If these steps are followed, reviewers should have a hard time denying a case like this.