4.
Current Procedural Techniques (CPT codes), International
Classification of Disease (ICD-9 codes)
CPT codes or Current
Procedural Techniques codes and ICD-9 or International Classification of
Disease codes (9th edition) are determined by the American
Medical Association (AMA). New codes are created every 10 years. They will
often make the difference in how, when and what you will be paid.
The most common codes used by
massage therapists are codes that are often used by physical therapists as
the massage profession does not have their own category (yet!). There
really are not any regulations as to who can use the codes as long as the
health care provider is properly trained and licensed. (ie. A physician can
do massage and bill 97124 as long as they have training in massage). If
another health care practitioner bills for the same code on the same date,
you may not be paid (concurrent care). (If a chiropractor sees the
patient on the same day as you and bills for 1 unit of 97124 and you bill 4
units of 97124, you will not be paid for 1 unit if that goes over the
allowable number of units.)
97124- Therapeutic
procedure, one or more areas, each 15 minutes: massage including effleruage,
petrissage and/or tapotement (stroking, compression, percussion; therapeutic
massage.
97140- Manual Therapy
techniques: mobilization, manipulation, manual lymphatic drainage, manual
traction, one or more regions, each 15 minutes.
97122- Therapeutic
procedure, one or more areas, each 15 minutes: Neuromuscular re-education of
movement, balance, coordination, kinesthetic sense, posture and
proprioception. (this would include Proprioceptive Neuromuscular
Facilitation (PNF), Feldenkrais but not St. John’s Neuromuscular Therapy.)
97250 – myofascial
release/soft tissue mobilization; This code has supposedly been
discontinued, but may be still recognized by some L&I or WC.
There is much controversy
over which codes to use. Often an insurance company will pay more for
different codes. Even if a company says that you can bill a certain code, it
is your responsibility to make sure that you are legally able to use that
code. How one does that is a complete mystery. Even among experts in the
profession there are many “opinions” as to what are the proper codes. Some
say 97124 is only for “relaxation massage”. There is one insurance company
here that will pay for that code only (not 97140 or any other code). There
is also much controversy over what relaxation massage is compared to medical
massage.
Some miscellaneous codes that
are often questionable at this time are:
97018 – paraffin bath
97022- whirlpool
97026 -infrared
97122- traction, manual
97530- therapeutic
activities, each 15 minutes
97110- therapeutic exercise,
each 15 minutes
