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Dynamic Chiropractic – December 3, 2007, Vol. 25, Issue 25

Codes for Soft-Tissue Work

By Samuel A. Collins

Q: What codes are available for soft-tissue work? I am confused as to which codes are appropriate for massage, trigger-point therapy, myofascial release, active release, etc.

A: There are two choices of physical medicine codes for the typical soft-tissue work performed by doctors of chiropractic.

Massage, 97124, and manual therapy, 97140, are the two available codes. However, the dilemma you are addressing is regarding which code is appropriate based on the performance and purpose of the soft-tissue technique you are employing.

Massage (97124) is a therapeutic procedure and a 15-minute service that requires direct contact by the doctor or therapist. Multiple units of billing may be utilized when more than 15 minutes of massage is performed. The definition of massage, per CPT 2007, is "massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)." Massage is regarded to effect changes to the soft tissues for muscle relaxation, increase localized circulation, reduce inflammation, soften scar tissue or mobilize mucous secretions in the lungs via tapotement and/or percussion.

Manual therapy (97140) also is a therapeutic procedure requiring direct contact by the doctor or therapist, and a 15-minute service such as massage. The definition of manual therapy, per CPT 2007, is "manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage and manual traction), one or more regions, each 15 minutes." The CPT manual further notes that "myofascial release" should be coded under 97140.

For specificity of the question posed, the focus of the service discussed under 97140 will be myofascial release. Specifically, myofascial release has been determined to be a variety of manual techniques (passive and/or active) intended to affect the soft tissues. The purpose of myofascial release generally is defined to reduce tightened or shortened soft tissue (fascia, muscles, tendons and trigger points) secondary to fibrosis, adhesions, scarring, etc. Myofascial release is a much more intense, typically deeper and more forceful service compared to massage. I had one person once describe it as "tenderizing meat." If you have ever had it done, you likely will agree.

The methods and style of massage or myofascial release can vary greatly between providers, but the services definitely are distinct in performance. Furthermore, the outcomes of each have definitive delineation.

If it is simple relaxation, reduction of spasm and circulation, massage likely would be the treatment of choice and would encompass the less-intense methods of massage techniques. If there is a need to reduce soft-tissue adhesions, break up active trigger points, lengthen the muscle, etc., the preferred method would be myofascial release, as massage would not effect the changes needed, compared to the deeper and more intense methods of myofascial release.

The choice of code is up to the provider, but the provider must be able to defend the choice based on their notes and specificity of the services provided. For either massage or myofascial, it's imperative to be clear on the specific goals, application and time spent, as doing so will clearly identify the specific service provided.

If you use terms such as "trigger-point therapy" in your notes, be aware there is not a clear definition that is universally accepted. Therefore, further explanation would be necessary. While myofascial likely is the service for "trigger-point therapy,"this is not clear from just the statement alone, but instead from a description of what specifically was done. For example, if a provider stated they were doing "spasm therapy," most providers would not be able to state if that therapy was massage or myofascial without further exposition. Generally, services such as "trigger-point therapy" and "active release" will fall under myofascial release, but again, ultimately it will depend on the style and purpose.

Of special note to California providers is the addition of a third code for soft-tissue work in the California Workers' Compensation system. California workers' comp offers three code sets for soft-tissue services; massage 97124, myofascial release 97250 (note that this code is used for California workers' compensation only, as that system does not utilize 97140), and 97610 soft-tissue mobilization. This third code for soft-tissue mobilization is what many in California refer to as a "tweener," meaning the soft-tissue work is not as minimal as massage but not as intense as myofascial requires. It's somewhere between the two. A provider might feel that the services, while not quite fitting the needs to qualify for myofascial release, are not as simplistic as massage and would have this code available for the service.

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