19-NC… What It Means and How to Use it in the Real World

By now you must have noticed the code “19-NC” cropping up on your service slips pretty frequently. As you were told in class, this is a new internal code being used in the clinic to track your use of soft tissue work that doesn’t qualify for a full 97124 (massage) or 97140 (manual therapy) because you didn’t do it for a long enough time. States are starting to require some physiotherapy hours for graduates seeking a license there (California comes to mind), so the “19-NC’s” add up to help out with these hours.

Keep in mind that 19-NC is an internal code used in the college clinic system only. It is not a real procedural (CPT) code, so once you walk across the stage at graduation, forget it ever existed! In the real world, soft tissue work falls under one of two codes:

• 97124 (massage) – more or less what it sounds like… the patient is passive and the doctor (or better yet, your employed massage therapist) performs a service to increase tissue relaxation and promote circulation. This code encompasses superficial, effleurage, petrissage, percussion, pressure point (acupressure), trigger point and deep-tissue techniques. Using a mechanical massager like a Genie-Rub or G5 would qualify for this code, too. 
• 97140 (manual therapy) – this code includes manual traction, manual lymphatic drainage, joint mobilization, myofascial release and non-chiropractic manipulation. The main distinction between the techniques that fall under this code and 97124 is specificity. Massage has general benefits and is usually applied to a fairly large area, versus manual therapy that is usually applied to a small area or specific muscle with the intent of reducing fibrous adhesions or something similar. Your Graston and PNF (ART-like) stretching would fall into this category.

The other key to using these codes is that they are time-dependent and require constant attendance. Using one of these codes tells an insurance company that you did one unit, or 15 minutes, of this type of work. So, when you use these codes in the clinic, you are telling us you did these procedures for 15 minutes, too, which very few interns really do. Rather than not getting credit for the work you did do, the clinic administration uses “19-NC” to show you did the work, but not enough to be considered a full 15-minute unit.

In the real world, you use a modifier to the code to tell the insurance company the same thing. the modifier “-52″ is used for “reduced service.” Let’s say you spend 5 minutes with a patient doing Graston on their Iliotibial Band. You can’t bill this as a full 97140 because you didn’t do it for 15 minutes, but you don’t want to not bill for it at all because you need to get paid for what you do. So, you would code this service as 97140-52, which tells the insurance company you did this type of work, but not enough to bill for a full unit. When the insurance company reimburses you, they will pay at less than the regular amount for a full unit of this code, so it works out as it should. On the other hand, let’s say your massage therapist performs 30 minutes of massage on a patient, you would bill two units of 97124 and get paid whatever the approved reimbursement is, times two.

Things get a little more complicated in billing for these codes for two reasons: different people define “time” in different ways, and insurance companies get paranoid when you start lumping a lot of 97140, 97124 and 9894x’s (adjustment codes) together on the same visit. In general, if you perform a 97140 or 97124 on a patient the same day as an adjustment, you need to use another modifier, -59. This tells the insurance company that the service was separate and distinct from your other services. Typically, even then, insurance companies will not pay for both a soft tissue and adjustment service in the same region on the same day, so you need to be aware of this and charge your patients accordingly. Every insurance company is different in this regard, which is why you need to verify insurance carefully and also attend your state-sponsored “Billing 101″ and “New Doctor” seminars.

As far as the interpretation of time goes, when I was in private practice my goal was to keep everything above the table and not get “fancy” or “creative” with how I did things. Worked well for me. To me, 15 minutes was 15 minutes. My two massage therapists worked in increments of 15 minutes. According to most billing experts, however, the time it takes to determine the need to administer these codes is also part of the 15 minute unit, so the history and exam you or a massage therapist would do before rendering one of these codes technically counts as part of the time. I don’t know if that’s true or untrue, so I’ll let you make that decision for yourself. Furthermore, it is widely believed that the services are to be billed for the “closest time to that unit,” so “one unit” really means anything from 8-22 minutes, “two units” really means 23-38 minutes, and so on. Again, I don’t know how true this is.

So, now you know what 19-NC means and how you will apply the same idea to real CPT codes in your practice with the real modifiers that go along with them.