How To Use CPT Code 98943

CPT 98943 refers to chiropractic manipulative treatment (CMT) performed on one or more extraspinal regions. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 98943.

1. What is CPT 98943?

CPT 98943 is a medical billing code used to describe chiropractic manipulative treatment (CMT) performed on one or more extraspinal regions. This code is utilized by medical coders and billers to accurately document and bill for chiropractic services provided to patients. The treatment involves the application of various techniques and modalities to influence joint and neurophysiological function in the targeted extraspinal regions.

2. 98943 CPT code description

The official description of CPT code 98943 is: “Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions.”

3. Procedure

The 98943 procedure involves the following steps:

  1. The provider, typically a qualified chiropractic professional, takes a detailed medical history from the patient.
  2. The provider may also take X-rays of the target anatomical site.
  3. Based on the initial investigation, the provider decides on a course of treatment.
  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 one or more extraspinal regions.
  6. The treatment course typically requires several sessions with the provider for completion.

4. Qualifying circumstances

Patients eligible to receive CPT code 98943 services are those experiencing pain, discomfort, or dysfunction in one or more extraspinal regions. These regions include the head, neck, upper extremities, lower extremities, ribs, and abdomen. The provider must determine that chiropractic manipulative treatment is medically necessary and appropriate for the patient’s condition. Additionally, the patient must not have any contraindications to chiropractic care, such as certain spinal disorders or fractures.

5. When to use CPT code 98943

It is appropriate to bill the 98943 CPT code when the provider performs chiropractic manipulative treatment on one or more extraspinal regions to address pain, discomfort, or dysfunction. The treatment must be medically necessary and appropriate for the patient’s condition, and the patient must not have any contraindications to chiropractic care.

6. Documentation requirements

To support a claim for CPT 98943, the following information must be documented:

  • Patient’s medical history, including any relevant diagnoses and symptoms
  • Physical examination findings, including the affected extraspinal regions
  • Any diagnostic imaging results, such as X-rays
  • Treatment plan, including the number of sessions and specific techniques or modalities used
  • Progress notes for each treatment session, detailing the services provided and the patient’s response to treatment
  • Any referrals or consultations with other healthcare providers

7. Billing guidelines

When billing for CPT code 98943, it is essential to follow payer-specific guidelines and rules. Some payers may require preauthorization or have specific documentation requirements. Additionally, if a significant, separately identifiable evaluation and management (E/M) service is performed on the same date, modifier 25 should be appended to the E/M code. It is crucial to check with individual payer policies to ensure accurate billing and reimbursement.

8. Historical information

CPT 98943 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); extraspinal, one or more regions.”

9. Similar codes to CPT 98943

Five similar codes to CPT 98943 and how they differentiate are:

  • CPT 98940: This code represents chiropractic manipulative treatment for one to two spinal regions, rather than extraspinal regions.
  • CPT 98941: This code is used for chiropractic manipulative treatment involving three to four spinal regions, instead of extraspinal regions.
  • CPT 98942: This code covers chiropractic manipulative treatment for five spinal regions, not extraspinal regions.
  • CPT 97140: This code is for manual therapy techniques, such as mobilization or manipulation, which may be performed on various body regions but is not specific to chiropractic care.
  • CPT 97124: This code is for therapeutic massage, which may be performed on various body regions but does not involve chiropractic manipulative treatment.

10. Examples

Here are 10 detailed examples of CPT code 98943 procedures:

  1. A patient with chronic headaches receives chiropractic manipulative treatment targeting the cervical and occipital regions.
  2. A patient with shoulder pain undergoes chiropractic manipulative treatment focusing on the shoulder joint and surrounding soft tissues.
  3. A patient with hip pain receives chiropractic manipulative treatment targeting the hip joint and surrounding muscles.
  4. A patient with rib pain undergoes chiropractic manipulative treatment focusing on the affected rib and surrounding soft tissues.
  5. A patient with wrist pain receives chiropractic manipulative treatment targeting the wrist joint and surrounding structures.
  6. A patient with knee pain undergoes chiropractic manipulative treatment focusing on the knee joint and surrounding muscles.
  7. A patient with TMJ dysfunction receives chiropractic manipulative treatment targeting the temporomandibular joint and surrounding structures.
  8. A patient with elbow pain undergoes chiropractic manipulative treatment focusing on the elbow joint and surrounding soft tissues.
  9. A patient with ankle pain receives chiropractic manipulative treatment targeting the ankle joint and surrounding structures.
  10. A patient with foot pain undergoes chiropractic manipulative treatment focusing on the foot joints and surrounding soft tissues.

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