When I review chiropractic records, it seems that some chiropractors like to stick with passive modalities, in addition to the chiropractic adjustment, while others like to perform or supervise therapeutic procedures with patients.
The first thing to understand is that these procedures are not just for PAIN. A therapeutic procedure is defined as “a manner of affecting change through the application of clinical skills and/or services that attempt to improve function.” This means that you need to document some type of functional deficit to that area, which is most easily done with functional outcome questionnaires.
The most common therapeutic procedures I see are Manual Therapy (97140) and Therapeutic Exercise (97110). Unfortunately, many times these codes are disallowed, due to “not being supported by the documentation.”
Let’s start with Manual Therapy (97140)
This code is not the same as Massage (97124). Massage is defined by CPT as “effleurage, petrissage, and tapotement.” Manual Therapy is defined by CPT as “mobilization/manipulation, manual lymphatic drainage, manual traction.” According to CPT, manual therapy is performed “in order to increase functional performance, increase range of motion, decrease inflammation and reduces muscle spasms.” Notice it says nothing about PAIN. To justify manual therapy (97140), you would need to document some type of decrease in functional performance, decrease in range of motion, increase in inflammation or the existence of muscle spasms/trigger points. Don’t forget, though – manual therapy is not billable when performed to the same area to which CMT was performed.
Therapeutic Exercise (97110)
According to CPT, therapeutic exercise is performed “in order to develop strength and endurance, range of motion and flexibility.” That means, to justify this procedure, you would need to document some type of abnormality of strength and endurance, range of motion or flexibility.” Again, most records that I review mention nothing to do with any of that. Again, notice that the definition has nothing to do with PAIN. I think the easiest way to justify this procedure is to note on each visit it is performed if there is an increase in pain with certain planes of motion. There is no requirement to measure range of motion on every visit, but you would need to document SOMETHING about abnormal range of motion on these visits. Pain by itself would not be enough, but pain WITHrange of motion would.