How To Use CPT Code 98942

CPT 98942 refers to chiropractic manipulative treatment (CMT) involving five spinal regions. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 98942 procedures.

1. What is CPT 98942?

CPT 98942 is a medical billing code used to describe chiropractic manipulative treatment (CMT) that involves the manipulation of five spinal regions. This code is used by medical coders and billers to accurately document and bill for the services provided by a chiropractic professional during a patient’s treatment course.

2. 98942 CPT code description

The official description of CPT code 98942 is: “Chiropractic manipulative treatment (CMT); spinal, 5 regions.”

3. Procedure

The 98942 procedure involves the following steps:

  1. The chiropractic professional takes a detailed medical history from the patient.
  2. X-rays of the target anatomical site may be taken.
  3. The provider decides on a course of treatment based on the initial investigation.
  4. The patient is instructed to lie down on a special treatment table adjusted to their height.
  5. The provider performs therapy ranging from light touching to vigorous manipulation and massaging on five spinal regions.
  6. The treatment course typically requires several sessions with the provider for completion.

4. Qualifying circumstances

Patients eligible to receive CPT code 98942 services are those who require chiropractic manipulative treatment for five spinal regions. This may include patients with chronic pain, musculoskeletal disorders, or other conditions that can benefit from chiropractic care. The chiropractic professional must determine the necessity of the treatment based on the patient’s medical history, examination findings, and diagnostic imaging results.

5. When to use CPT code 98942

It is appropriate to bill the 98942 CPT code when a chiropractic professional performs chiropractic manipulative treatment on five spinal regions during a single session. The provider must determine that the treatment is medically necessary and document the rationale for the treatment in the patient’s medical record.

6. Documentation requirements

To support a claim for CPT 98942, the following information must be documented in the patient’s medical record:

  • Patient’s medical history and presenting symptoms
  • Physical examination findings
  • Diagnostic imaging results, if applicable
  • Treatment plan, including the number of spinal regions to be treated and the frequency of treatment sessions
  • Progress notes for each treatment session, detailing the specific spinal regions treated and the techniques used
  • Any changes in the patient’s condition or treatment plan

7. Billing guidelines

When billing for CPT code 98942, it is essential to follow the appropriate billing guidelines and rules. These may include:

  • Ensuring that the treatment is medically necessary and supported by documentation in the patient’s medical record
  • Using the correct CPT code based on the number of spinal regions treated during the session
  • Appending modifier 25 to a significant, separately identifiable evaluation and management (E/M) service performed on the same date, if applicable, and following payer policy
  • Verifying payer-specific requirements and policies for billing CPT 98942

8. Historical information

CPT 98942 was added to the Current Procedural Terminology system on January 1, 1997. The code was changed on January 1, 2009, with the previous descriptor being “Chiropractic manipulative treatment (CMT); spinal, five regions.”

9. Similar codes to CPT 98942

Five similar codes to CPT 98942 differentiate based on the number of spinal regions treated during the chiropractic manipulative treatment session. These codes are:

  • CPT 98940: Treatment involving one to two spinal regions
  • CPT 98941: Treatment involving three to four spinal regions
  • CPT 98943: Extraspinal manipulative treatment
  • CPT 98925: Osteopathic manipulative treatment (OMT) involving one to two body regions
  • CPT 98926: OMT involving three to four body regions

10. Examples

Here are 10 detailed examples of CPT code 98942 procedures:

  1. A patient with chronic low back pain, mid-back pain, and neck pain receives chiropractic manipulative treatment on the lumbar, thoracic, and cervical spinal regions, as well as the sacral and pelvic regions.
  2. A patient with a history of spinal stenosis in multiple regions undergoes chiropractic manipulative treatment targeting the cervical, thoracic, lumbar, sacral, and pelvic regions to alleviate pain and improve mobility.
  3. A patient with scoliosis receives chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address spinal curvature and associated pain.
  4. A patient with a herniated disc in the lumbar region and degenerative disc disease in the cervical and thoracic regions receives chiropractic manipulative treatment on all five spinal regions to alleviate pain and improve function.
  5. A patient with a history of whiplash injury undergoes chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address pain and restricted range of motion.
  6. A patient with chronic headaches and neck pain receives chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address the underlying musculoskeletal issues contributing to their symptoms.
  7. A patient with fibromyalgia undergoes chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address widespread pain and stiffness.
  8. A patient with a history of multiple spinal surgeries receives chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address post-surgical pain and mobility issues.
  9. A patient with a history of spinal trauma undergoes chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions to address pain, stiffness, and mobility issues resulting from the injury.
  10. A patient with a history of chronic pain and multiple spinal conditions receives chiropractic manipulative treatment on the cervical, thoracic, lumbar, sacral, and pelvic regions as part of a comprehensive pain management plan.

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