BCBS regarding 97112, 97124, and 97140

[Guest guest]

The 2008 NCCI Edits (January - March) had 97124 as a subset 1 with CMT (98940-98943). The current listing on CMS does not show a subset 1 or 0, implying no restriction on submission.

For those now totally confused - subset 1 implies that the code must be submitted with a modifier indicating a distinct and separate procedure such as 97140-59. Subset 0 means that the two codes are mutually exclusive regardless of the modifier or other conditions.

I would inquiry what version of NCCI Edits BCBS is using. It would appear out of date. This is an issue that could be directed to the associations to pool the data, much like Dr. Saboe is doing on the Workers' Compensation issue. Coding is not an issue that is likely to come under concern to the OBCE, at least where it is a policy of an insurance company on reimbursement. It may be an effective matter where associations from several states pool their information.

Tom Freedland

Dear Colleagues,

I recently received correspondence from BCBS regarding certain treatment codes. Instead of paraphrasing the letter, I will quote it directly. “Our review of the appeal you recently submitted the for the member and service date listed above is complete. We have determined that the original decision is correct and will be upheld.

The basis for Regence Blue Cross Blue Shield of Oregon’s clinical editing is the national correct coding initiative. Per CCI, 97124 is considered incidental to 98941. It has a superscript of one (1) indicating that, if appropriate, a modifier may be used to differentiate between services.

In addition, and NCCI written policy (Chapter 11,) states “Medicare covers chiropractic manipulative treatment of 5 spinal regions. Physical medicine and rehabilitation services described by CPT codes 97112, 97124 and 97140 are not separately reportable when performed in a spinal region undergoing CMT.â€

Per the clinical information submitted, however it appears that the massage services were actually performed by a separate provider.

Please note, if an alternative medicine provider (i.e. Naturopath, massage therapist, acupuncturist) practices in your office the alternative medicine provider needs to report their services under their own provider number rather than to submit services under the chiropractor’s provider number. They would need to contact a provider relations representative to obtain their own provider number and report the services they provide under their own provider number. Since the massage services were not performed by Dr. Sorah personally, no additional allowance will be made on this claim at this time. You may resubmit to claim under the appropriate provider of the services for reconsideration.

I have a number of issues with this correspondence. First of all, a-59 modifier was used with the 97124 code to indicate that it was a wholly separate and identifiable service. Second of all, I knew that 97140 was not reportable if performed in the same region as CMT; however, I did not understand that to be the case with 97124. Thirdly, the massage service was provided by an LMT who is also a CA and my employee. This treatment was performed per my instructions and under my direction. Therefore, in this situation, I believe it would be incorrect to use the provider’s own name and provider number. It seems that this would affect all of us who utilize CA’s to perform therapeutic activities in our offices. Are most of these companies clueless when it comes to the laws regarding CA’s?

It would be great to get some feedback on this matter. Thanks in advance.

Sorah, DC

Corvallis, OR Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out!