CPT Code 98943: Chiropractic Manipulative Treatment (CMT); Extraspinal, 1 or More Regions

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 98943: Chiropractic Manipulative Treatment (CMT); Extraspinal, 1 or More Regions

Chiropractic Manipulative Treatment (CMT) is a common procedure performed by chiropractors to treat a variety of conditions. CPT code 98943 is used to report the chiropractic manipulative treatment of one or more extraspinal regions. Extraspinal regions include the head, upper and lower extremities, rib cage, and abdomen.

CMT is a manual therapy technique that involves the application of controlled force and leverage to joints and soft tissues. It is used to treat a variety of conditions, such as:

Here’s what chiropractors need to know about using CPT code 98943.

Category or Type of Service

CPT code 98943 is a Chiropractic Manipulative Treatment (CMT) code. It is used to report the chiropractic manipulative treatment of one or more extraspinal regions.

Billing Interval

This code is billed per session. A session is defined as the chiropractic manipulative treatment of one or more extraspinal regions during a single patient visit.

When Should Chiropractors Use This Code?

Chiropractors should use 98943 to report the chiropractic manipulative treatment of one or more extraspinal regions. This code can be used to treat a variety of conditions, including:

• Shoulder pain
• Hip pain
• Knee pain
• Elbow pain
• Ankle pain
• Musculoskeletal disorders of the extremities
• Postural issues related to the extremities

When Should Chiropractors Not Use This Code?

Chiropractors should not use 98943 to report the chiropractic manipulative treatment of the spine. In these cases, other CPT codes are more appropriate.

Use of this code is also inappropriate to report the CMT of extraspinal regions when it is performed as part of an evaluation and management (E/M) visit or a chiropractic manipulative treatment (CMT) session. In these cases, the CMT is considered to be included in the overall service and should not be billed separately.

Which Modifiers Can Be Used With This Code?

The following modifier codes can be used with CPT code 98943:

• 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.
• Modifier AT: Acute treatment

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

The documentation requirements for CPT code 98943 are more stringent than the documentation requirements for other CMT codes. The following billing guidelines and documentation requirements apply to this code.

The documentation must include:

• The patient’s chief complaint
• The presenting signs and symptoms
• A detailed description of the patient’s condition
• The specific extraspinal regions treated
• The specific techniques used
• The assessment and plan
• The patient’s response to treatment

The documentation must be clear and legible, and it must be signed and dated by the chiropractor who performed the treatment.

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 98943 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 are examples of ICD-10-CM codes often used with CPT code 98943:

• M25.511: Pain in right shoulder
• M25.512: Pain in left shoulder
• M54.4: Piriformis syndrome
• M79.61: Bursitis, shoulder
• M77.01: Medial epicondylitis

What Are Common Mistakes Made Specific to This Code?

Some common mistakes made with code 98943 include:

• Billing the code when the CMT is performed as part of an E/M visit or CMT session
• Incorrectly using this code to report the treatment of spinal regions
• Failure to document medical necessity for the treatment
• Failing to document the specific extraspinal regions treated
• Failing to document the specific techniques used
• Failing to document the patient’s response to treatment

What Are Potential Audit Triggers Specific to CPT code 98943 and How Can I Avoid Them?

Some potential audit triggers specific to CPT code 98943 include:

• Overuse of this code
• Billing the code when the CMT is performed as part of an E/M visit or CMT session
• Lack of documentation supporting the use of this code
• Failing to document the specific techniques used
• Failing to document the patient’s response to treatment
• Billing the code for a service that was not medically necessary
• Billing the code in combination with others services that are not separately identifiable

To avoid these audit triggers, ensure that the use of this code is medically necessary and properly documented.

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

Here are some tips to simplify billing and coding and avoid audit triggers:

• Stay up-to-date on coding guidelines. The coding guidelines for CPT codes are constantly changing. It’s important for chiropractors to stay current on these guidelines to ensure that they are billing their services correctly.
• Train your staff on billing and coding. All staff members who are involved in the billing and coding process should be trained on the correct procedures. This will help to ensure that the codes are used correctly and that the billing process is efficient.
• Review billing and coding processes regularly. Chiropractors should review their billing and coding regularly to identify any potential errors. This will help to avoid audits and ensure that they are getting paid for the services they provide.
• Use a cloud-based EHR system that includes built-in coding tools. This can help chiropractors to ensure that they are using the correct codes and that their documentation is complete.

How Cloud-Based ChiroTouch Simplifies Billing

Cloud-based ChiroTouch is an invaluable tool for chiropractors that makes billing easier in multiple ways.

ChiroTouch offers:

• Streamlined billing workflows: ChiroTouch makes billing tasks more efficient and less prone to human error.
• An all-in-one dashboard. ChiroTouch makes it easy for all staff members to find the information they need — all in one place.
• Automated insurance processing: With automatic insurance processing, ChiroTouch reduces the time spent on manual tasks and minimizes errors.
• Automatic posting: Payments go straight to patient accounts, avoiding issues such as double charges and miscommunications.
• Flexible payment options: ChiroTouch offers various ways for patients to pay, making it easier for them to stay on top of their payments.
• Clearinghouse integration: ChiroTouch makes processing insurance claims quick and easy because everything is in one place.
• Ability to keep information separate: ChiroTouch lets you keep track of different case types separately, such as personal injury and workers’ compensation cases, which makes managing billing data more efficient.

What’s more, ChiroTouch helps to ensure compliance and lower your risk of audits with features like these:

• Easy access to information: With ChiroTouch, you can easily pull up patient information and billing codes.
• Automated billing and insurance payments: ChiroTouch saves time and improves accuracy by automating the billing and posting of insurance payments.
• Simplified Explanation of Benefits (EOBs): ChiroTouch makes understanding EOBs easier by syncing them directly into the system.
• Educational resources: ChiroTouch helps you stay up to date with learning resources.

To learn how the cloud version of ChiroTouch can help you run a more productive and profitable practice, book a demo today!