Is your chiropractic clinic struggling to document and justify CPT code 98941? Let us simplify this code for you! Every year, 35 million people in the U.S. turn to chiropractors for managing their pain. The most popular treatments? Spinal manipulation involving several regions!
We know you might be an expert in this area, but your weakest link may be billing. And why wouldn’t it be, since there are several codes for this treatment, depending on how many regions you manipulated? CPT code 98941 is quite popular.
Unfortunately, it is often flagged by payers due to incorrect usage or incomplete documentation. We want your practice to be fully prepared for audits. Therefore, today, we will help you understand the correct usage of this code.
CPT Code 98941 – Description
As you may have already gathered, CPT code 98941 refers to a chiropractic manipulative treatment (CMT). But how does it differ from other CMT codes? It specifically covers spinal manipulation that involves three to four regions.
During this service, chiropractors use their hands or a device to apply controlled thrust to a patient’s spinal joint. In simple terms? They manually correct spinal dysfunctions to reduce pain and improve neurophysiological functionality. Chiropractors use this code to notify insurance companies that they targeted three to four spinal regions during CMT, such as
- Cervical region (neck)
- thoracic region (mid-back portion)
- lumbar spine (lower-back portion)
- Sacral region (tailbone)
- Pelvic area (bony structure at the base of the spine)
Scenarios Where CPT Code 98941 is Applicable
Did you get some clarity with the description? Or are you still confused about CPT code 98941? You can explore the following scenarios to determine if the 98941 CPT code is appropriate for your current case.
Treating Chronic Back Pain in a Working Graduate Student
Did you know that 8.2% of American adults live with severe chronic back pain? Among them, 74.8% have mobility difficulties. Since this condition is more common among women and overweight individuals, let’s come up with a similar scenario for the 98941 CPT code.
Suppose a 27-year-old working grad student struggles with daily activities. The main reason? Due to prolonged sitting and poor posture, she has been experiencing dull pain in her lower back and tailbone (coccydynia) for two months. Eventually, she is unable to sit for even an hour due to the persistent pain.
She finally seeks help from a chiropractor to improve her condition. The chiropractor orders imaging studies to identify the cause of the patient’s pain and any structural issues. He then performs manipulative therapy in the lumbar, sacral, and pelvic regions and bills for the service using CPT code 98941.
Lumbar Strain in a Professional Weightlifter
Lower back injuries, including muscle strains, are common among sportsmen. In fact, these injuries account for 7 to 13% of all sports injuries among intercollegiate athletes in the U.S. Considering this, let’s assume a 26-year-old professional weightlifter experiences a lumbar strain (injury to the lower back). He sustained this injury due to excessive lifting and poor posture.
After receiving a proper diagnosis and treatment plan, he visits a chiropractor to help manage his pain. The healthcare professional applies quick thrusts to the spine, focusing on three or four regions, including the lumbar region. He then uses CPT code 98941 to bill for this service.
Neck Pain Due to Osteoarthritis
Neck pain (cervicalgia) is a common musculoskeletal disorder, affecting 30% of adults in the USA. Common causes include muscle strains, poor posture, awkward sleeping positions, physical injuries, or underlying conditions.
For the final example, imagine a 62-year-old woman with long-term osteoarthritis. Due to aging and natural wear and tear, several parts of her cervical spine have deteriorated. As a result, she experiences increasing neck pain.
Knowing that chiropractic care is a safe and effective option for pain relief, she visits a chiropractor. After examining her condition, he uses manual therapy to treat her acute neck pain, targeting the cervical, thoracic, lumbar, and sacral regions. His billing team then uses CPT code 98941 to report the procedure.
Applicable Modifiers for CPT Code 98941
If you are wondering whether you can bill for CPT code 98941 as is, or do you need to attach some modifiers, the answer depends on your specific situation and payer requirements. You can use the following modifiers with this code:
Modifier 59
Need a separate payment for spinal manipulation in three to four regions? You can apply modifier 59 to CPT code 98941 if it is unrelated to other chiropractic services you performed on the same day. However, make sure to check the NCCI edits before billing your codes, and apply modifier 59 only when it is appropriate.
Modifier AT
Was the chiropractic adjustment you performed part of an active treatment for a partial dislocation (subluxation)? In that case, append modifier AT to CPT code 98941. This modifier notifies payers that spinal manipulation in three to four regions was medically necessary.
CPT Code 98941 – Billing & Reimbursement Guidelines
Are denials for CPT code 98941 getting out of hand? Follow our reimbursement and billing guidelines for spinal manipulation to avoid this problem.
Use This Code to Report Adjustment of 3-4 Spinal Regions
Remember, there are different codes for spinal manipulation, each representing a different number of regions adjusted. The 98941 CPT code only applies to spinal manipulation in three to four areas. Therefore, don’t confuse this code with CPT codes 98940 and 98942.
Maintain Clear & Complete Documentation
Back up your 98941 claims with complete documentation. As we mentioned earlier, payers deny chiropractic claims due to missing notes and a lack of medical necessity. Therefore, document the entire spinal manipulation service to avoid these issues. You must record:
- Patient complaints (stiffness, pain, limited motion)
- Test results and objective findings
- Reason for performing the service (active, corrective, or maintenance treatment)
- Names and number of spinal regions adjusted
- Manipulation techniques
- Patient’s response to treatment
Attach Appropriate Modifiers
As we discussed in the previous section, you must apply modifier AT to CPT code 98941 if you have performed manual manipulation to treat an acute or chronic subluxation. Otherwise, payers, especially Medicare, may deny your claim.
Review Payer Policies
It is quite challenging to receive timely reimbursements for chiropractic claims. This is primarily due to payers’ varied policies and billing requirements. For example, Medicare only covers medically necessary spinal manipulations. In simple words? It will only pay you if you perform a chiropractic adjustment to correct a vertebral subluxation.
Medicare does not cover other chiropractic services or tests. On the other hand, private insurance companies may have different policies for this code. Therefore, always verify their requirements before filing a claim for CPT code 98941.
Summary
Ready to tackle payers’ billing demands for spinal manipulations? We hope that you can now confidently file claims for CPT code 98941. To sum up, this code specifies chiropractic adjustments in three to four spinal regions. Simply put, you can use this code to bill for manual manipulation techniques you employed to correct a patient’s spinal dysfunctions.
We have provided a detailed guide for the 98941 CPT code targeting all the common pain points, including documentation issues, to help you avoid denials. However, if you are still unprepared for payer audits, hand over everything to a professional medical biller. Many companies offering chiropractic billing services can help to improve your practice’s compliance.
