CPT Code 98942: Chiropractic Manipulative Treatment; Spinal, 5 Regions - Chirotouch

This quick reference guide to CPT code 98942 answers frequently asked questions from our community of chiropractors. Keep an eye out for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors. 

About CPT Code 98942: Chiropractic Manipulative Treatment (CMT); Spinal, 5 Regions

Chiropractic Manipulative Treatment (CMT) is a critical component of chiropractic care. CPT code 98942 is used when the chiropractor manipulates five regions of the spine in a single session.

Category or Type of Service

CPT code 98942 falls under the category of Chiropractic Manipulative Treatment (CMT). It is also a “separate procedure” code, meaning that it can be billed in addition to other services, such as an evaluation and management (E/M) visit or a physical therapy session.

Billing Interval

This code is billed per session. A session is defined as the chiropractic manipulative treatment involving five spinal regions.

When Should Chiropractors Use This Code?

Chiropractors should use 98942 to report the chiropractic manipulative treatment of five spinal regions in a single session. This code can be used to treat patients with a variety of conditions, including:

  • Chronic back pain
  • Neck pain
  • Headaches
  • Sciatica
  • Herniated disc
  • Scoliosis
  • Other spinal disorders

When Should Chiropractors Not Use This Code?

Chiropractors should not use 98942 if the treatment does not involve manipulation of five spinal regions. If fewer regions are treated, use one of these CPT codes instead:

  • 98940: Chiropractic manipulative treatment (CMT); spinal, one to two regions
  • 98941: Chiropractic manipulative treatment (CMT); spinal, three to four regions

Which Modifiers Can Be Used With This Code?

The following modifier codes can be used with CPT code 98942:

  • Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service.
  • Modifier 59: Distinct procedural service.

What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

The following billing guidelines and documentation requirements apply to code 98942:

  • The code should be billed with the appropriate modifier, if applicable.
  • The documentation must include the following:
    • The patient’s chief complaint
    • The history of present illness
    • The physical examination findings
    • The rationale for the CMT
    • The description of the CMT procedure
    • The patient’s response to the CMT procedure

Are There Specific Billing Guidelines That Apply to This CPT Code When It’s Used in Combination With Other Services?

According to the National Correct Coding Initiative (NCCI), CPT code 98942 can be billed in combination with other services if the services are medically necessary and separately identifiable from the other services provided.

What are Examples of ICD-10-CM Codes Often Used With This Code?

The following ICD-10-CM codes are examples of codes often used with CPT code 98942:

  • M54.5 Back pain
  • M51.1 Neck pain
  • G43.9 Headache, unspecified
  • M54.4 Sciatica
  • M51.26: Other intervertebral disc displacement, lumbar region
  • M41.9: Scoliosis, unspecified

What Are Common Mistakes Made Specific to This Code?

Some common mistakes made with code 98942 include:

  • Using the code for fewer than five spinal regions
  • Not documenting the manipulation of all five regions
  • Not establishing medical necessity for the treatment
  • Incorrect use of modifiers

What Are Potential Audit Triggers Specific to CPT code 98942 and How Can I Avoid Them?

Some potential audit triggers specific to CPT code 98942 include:

  • High frequency of use of this code
  • Lack of documentation supporting the medical necessity of the treatment
  • Inconsistent use of modifiers
  • Billing the code for a patient who has already received CMT from another provider on the same day
  • Billing the code for a patient who has not been seen by a chiropractor within the past 7 days

Note that audit triggers can vary depending on the specific policies of different insurance providers as well as updates to coding guidelines.

What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?

Chiropractors can implement several measures to enhance the precision and productivity of their clinic’s billing and coding procedures.

These measures include:

  • Regularly refreshing and expanding your understanding of CPT codes and billing regulations
  • Making certain that all paperwork is comprehensive, unambiguous, and adheres to billing standards
  • Conducting routine audits of your billing and coding procedures to spot and rectify inaccuracies
  • Investing in high-grade, modern EHR and billing software to simplify your billing and coding operations

Meet Our Billing and Coding Expert

For expert insight into optimizing your coding and billing processes, meet Kathy Mills Chang (also known as Kathy Weidner), founder and CEO of KMC University. As one of the country’s leading authorities on chiropractic billing, Kathy has plenty of tips to share to help you collect everything you’re owed while avoiding denials and audit risk.

Read our conversation with Kathy to learn how ChiroTouch can help you avoid billing and coding pitfalls.

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