We all know that at this day in age, insurance carriers seem to not even need a good reason to deny medical claims. It is a frustration that many chiropractors and their billing staff experience, but hopefully this article will clarify when to use the -59 modifier and how to dispute any denials that you receive.

The fact is that Chiropractic Manipulative Treatment is a SPECIFIC CHIROPRACTIC TREATMENT that influences joint and neuro-physiological functions to the joints of the spine and/or the extremities. This treatment may be accomplished using a variety of chiropractic techniques. The application of manual therapy code 97140 with the -59 modifier (manual traction, myofascial release, joint mobilization) is a specific separately identifiable PHYSICAL THERAPY as performed.

One of the things that we at Advanced Billing Professionals, Inc. do is first of all include the modifier whenever a Chiropractic Treatment and Manual Therapy is performed, and write a letter with the above description along with the AMA description of the 97140 (Manual Therapy) code:

Manual Traction

Process of drawing or pulling exerted by/performed by or with the hands.

Joint Mobilization

The act of obtaining motion in the setting of some impairment of normal motion. Mobilization infers a smaller application of force to gain motion in a more gradual fashion. The intended use of joint mobilization is where a level of force is applied to a stiff or immobile joint that is generally within the patients ability to tolerate without major sedation or anesthesia. The force applied will often not be sufficient to regain full motion at a single setting, depending on the degree of immobility of the affected area.

Myofascial Release/Soft Tissue Mobilization

The movement of contractile or inert tissues in such a way as to effect change in that structure or its related elements. The assessment and treatment are directed at soft tissues with the techniques being active, passive, or both, and may or may not include bone motion. The effect of this treatment may be demonstrated in a change in the targeted soft tissues, the articular structures, neural system, or vascular system. Examples of the use of soft tissue range from facilitation of fluid exchange and restoration of movement in the acutely edematous muscle lesion, to stretching of adaptive shortened contractile or connective tissue. The techniques are applied specifically at the targeted tissues, with skilled manual techniques, to facilitate the healing process or restore tissue to optimal functional capacity. When symptoms or complaints are of a soft tissue origin, soft tissue mobilization may be helpful in treating the pathology.

The fact is, no matter how often the insurance companies try to deny these codes when billed together, these services are distinctly separate and were performed on the basis of the patients medical necessity for their condition.