How to Use Soft-Tissue Procedure Codes

We visited this topic in another post, concerning the use of the internal clinic code 19-NC, but this is a more in-depth look at how and when to properly use soft tissue codes. This area gets a lot of chiropractors into trouble in practice, so start implementing this information in the clinic and you’ll be ready to continue good habits out into your own practice! Using the various codes available for soft-tissue work seems pretty straightforward, but I suspect that doctors and students are not given the best information at practice-building or technique seminars concerning how to use these codes.

 

Massage - 97124

Massage – 97124:

The massage code is separate and distinct from the other manual therapy and adjusting procedures you would be performing on a given day. Massage is used for soft-tissue work that is totally passive in nature, requiring no movement or work from the patient. The goal of massage is to relax tissues and promote circulation. Massage may be used to reduce edema or swelling, calm a muscle spasm, restore muscle function and improve joint range of motion. The procedures included in the 97124 massage code are effleurage, petrissage, percussion, superficial (Swedish) massage, pressure point (acupressure, trigger point, Nimmo, etc) work that is passive (as opposed to something like ART or Strain Counterstrain, as we’ll see in a moment) and the use of tools to accomplish the same thing, such as a “Thumper,” G5 massager, etc. Massage is generally given to a large area of the body and crosses multiple types of tissue in a general way (i.e. not making much of a distinction between muscle, tendon, ligament, etc. In some cases Graston or other instrument-assisted soft-tissue techniques may be considered a 97124 code, but usually it falls under another code described below. Of course, massage requires a doctor or therapist to be in constant contact with the patient.

Trigger Points - 97124

This code is billed in 15-minutes units. One unit of massage would be appropriate for 8-22 minutes of application. Two units would be used for 23-37 minutes of application, etc.

Manual Therapy – 97140:

This code encompasses a wide variety of services commonly performed by chiropractors, including manual traction, non-chiropractic manipulation (mobilization, for example), myofascial release, joint mobilization and lymphatic drainage. Techniques such as Strain Counterstrain, ART (MFR), muscle energy techniques and Graston would be most appropriately billed using this code.

As important distinction between manual therapy and massage is the specificity. Manual therapy is generally specific to a single tissue or muscle/joint. Massage, on the other hand, is more general in nature without much distinction to specific tissue types in the delivery of the therapy. For example, massage may be given to the entire back, whereas Graston would be isolated to the right upper trapezius.

 

Graston Technique - 97140

The intent of manual therapy is generally to work on fibrotic tissue and adhesions. The goal is to restore function to the target tissue. Manual therapy may be passive (from the patient’s perspective), such as in the case of most Graston techniques, or active, as in Strain Counterstrain or ART. Notes should always specify the specific area and time that was treated, as well as the technique used and any outcomes (improved ROM, improved tissue pliability, muscle function, etc). 

 

 

Neuromuscular Re-Education (97112):

This is an often misunderstood and improperly used code. It is used when re-training a body part to perform a task it was previously able to do. Physical and occupational therapists typically use this code for post-surgery, stroke or injury patients. It involves exercises that retrain the body part to do what it is commonly needed to do (standing, walking, flexing, extending, grip, etc). Balance, coordination, proprioception and posture may be a factor of this code, too. Chiropractors rarely engage in true neuromuscular re-education activities. Some types of postural rehabilitation and the use of wobble boards, for example, would be allowable under 97112, but the soft-tissue techniques mentioned above are never to be used with this code, contrary to what seminars may tell you!