If you are not performing rehabilitation in your clinic right now, you should consider doing rehab in the near future because it is these types of CPT® codes that are getting doctors paid better by the insurance companies. The insurance companies pay better because the patients not only get better faster, but the patients stay better longer.
| Table 1—Case Management Strategy
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Initial Visit-
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Questionnaire(s), Examination, X-rays, Therapeutic Modalities, Algometry (PPT testing)
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Second Visit-
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cROM Testing, CMT, Therapeutic Modalities
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Third Visit-
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cMT, CMT, Therapeutic Modalities
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Fourth Visit-
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PPT testing, CMT, Therapeutic Modalities
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Fifth Visit-
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CMT, Therapeutic Modalities
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Sixth Visit-
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CMT, Therapeutic Modalities
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Seventh Visit-
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CMT, Therapeutic Modalities
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Eighth Visit-
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CMT, Therapeutic Modalities
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Ninth Visit-
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CMT, Therapeutic Modalities
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Tenth Visit-
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CMT, Therapeutic Modalities
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Eleventh Visit-
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CMT, Therapeutic Modalities
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Twelfth Visit-
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Re-Exam,Therapeutic Procedures
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Thirteenth Visit-
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cROM Testing, CMT, Therapeutic Procedures
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Fourteenth Visit-
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cMT, CMT, Therapeutic Procedures
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Fifteenth Visit-
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PPT testing, CMT, Therapeutic Procedures
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Sixteenth Visit-
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CMT, Therapeutic Procedures
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Most modern chiropractic offices have a physical therapy/rehab department/room that is dedicated to performing the therapeutic modalities or therapeutic procedures (see Table 1). There are three reasons doctors of chiropractic should be performing therapeutic procedures:
1) business reasons—the reimbursement rate is very good for these codes
2) clinical reasons—the patients get well faster and stay well longer.1, 2
3) insurance reasons—insurance companies readily acknowledge doctors who are using these procedures The CPT® 2007 codebook defines therapeutic modalities and therapeutic procedures as:
Therapeutic Modalities—Any physical agent applied to produce therapeutic changes to biological tissue, including, but not limited to, thermal, acoustic, light, mechanical or electrical energy—essentially, the modalities such as Mechanical Traction, Ultrasound, Stim and Heat (MUSH). I call it MUSH because that it is what the insurance companies pay for these modalities—MUSH. There are two types of modalities: Supervised Modalities and Constant Attendance Modalities.
• Supervised Modalities—the application of a modality that DOES NOT REQUIRE direct (one on one) patient contact by the provider.
97010 Hot or Cold Packs
97012 Traction, Mechanical
97014 Electrical Stimulation, unattended 97018 Paraffin Bath
97022 Whirlpool
97024 Diathermy
97026 Infared
97028 Ultraviolet
• Constant Attendance Modalities—the application of a modality that REQUIRES direct, one on one, patient contact by the provider.
97032 Electrical Stimulation
97033 Iontophoresis
97034 Contrast Baths
97035 Ultrasound
97036 Hubbard Tanks
Therapeutic Procedures—a manner of effecting changes through the application of clinical skills and/or services that attempt to improve FUNCTION.
97110 Therapeutic Exercises
97112 Neuromuscular Re-education
97113 Aquatic Therapy
97116 Gait Training
97124 Massage
97140 Manual Therapy
97530 Therapeutic Activities
97535 ADL (home)
97537 ADL (work)
The insurance industry is moving toward a more active model of healthcare where the policy holder/patient is becoming more responsible for his/her own healthcare, meaning the doctor should place a patient in a treatment plan that allows a patient to move from a passive care model to an active care model. In this way, the patient takes ownership of his/her health, which allows the patient to do most of the work rather than the doctor (see Table 1).
The case management strategy in Table 1 is not set in stone. You still must think as a doctor. If the patient is ahead of the set schedule and you believe that the patient can tolerate some of the therapeutic procedures, stop the modalities and start the procedures.
An important tool in determining medical necessity of the therapeutic procedures and determining whether or not the patient can tolerate the therapeutic procedures revolves around functional diagnostic tests, such as computerized ROM testing, computerized muscle testing, and pain pressure threshold testing (algometry). Theses functional diagnostic tests can be found in Table 1 as well. The patient should be re-examined using these diagnostic tests to check whether or not the patient is getting better, staying the same, or getting worse.
Again, you still must think as a doctor and decide if what you are performing on the patient is getting adequate results. The patients, in most cases, will be able to tell you either verbally or non-verbally, in the form of their body movements, as to whether or not they are able to begin the therapeutic procedures.
If you want to modernize your clinic and/or provide more services, consider the higher paying therapeutic procedure codes. The increased income from these codes is well worth the effort. The only price it costs you is in terms of documenting the medical necessity; but that can be taken care of with the use of functional diagnostic tests that are payable by the insurance companies as well.
I urge you to take a look at getting your practice ahead of the curve so that you can stay in line with the changes in the healthcare reimbursement world.
1. Jan Lucas Hoving, PT, PhD; Bart W. Koes, PhD; Henrica C.W. de Vet, PhD; Danielle A. W.M. van der Windt, PhD; Willem J.J. Assendelft, MD, PhD; Henk van Mameren, MD, PhD; Walter L.J.M. Deville, MD, PhD; Jan J.M. Pool, PT; Rob J.P.M Scholten, MD, PhD; and Lex M. Bouiter, PhD. Manual Therapy, Physical Therapy, or Continued Care by a General Practiioner for Patients with neck Pain A Randomized, Controlled Trial. Annals of Internal Medicine, Vol.136 No. 10, Pgs 713-722 May 21, 2002.
2. Ongeborg BC Korthals-de Bos, Jan L Hoving, Maurits W van Tulder, Maureen PMH Rutten-van Mölken, Hermann J Adèr, Henrica CW de Vet, Bart W Koes, Hindrik Vondeling, Lex M Bouter. Cost Effectiveness of Physiotherapy, manual therapy, and General Practitioner Care for Neck Pain: Economic Evaluation Alongside a Randomised Controlled Trial. British Medical Journal; 326:911; April 26, 2003.
Dr. Dwight Whynot is a successful full-time private practitioner in Johnson City, Tennessee and a graduate of Logan College with a bachelor’s degree from Dalhousie University, Nova Scotia, Canada. Dr. Whynot gives license-renewal lectures on Evidence-Based Chiropractic Practices which are promoted by the EBC Seminars and sponsored by Myo-Logic and Spinal Logic Diagnostics. Dr. Whynot also gives license-renewal lectures to the medical community in Tennessee. For questions regarding evidence-based practice procedures, email [email protected]. For 6 and 12 hours CCE license renewal lecture dates and locations call Karl Parker Seminars at 1-888-437-5275 or visit www.EBCSeminars.com.