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Dynamic Chiropractic – July 29, 2010, Vol. 28, Issue 16

Billing Flexion-Distraction Services

By Samuel A. Collins

Q: I am very confused as to how to code for the use of flexion-distraction. I have always billed it as traction, but just recently heard that coding it in that manner is incorrect. What is the code that should be used for this type of service?

A: Coding of this service is often confusing and misunderstood. I think the primary reason for this confusion is because of the term used to describe the service, flexion-distraction. Once we see that language, it is common to think traction and bill it under the codes for traction. However, that is an incorrect assumption.

The coding for flexion-distraction is in fact chiropractic manipulation. Chiropractic manipulation 98940-98942 can be broadly organized into various styles of manipulation and mobilization. The best description of flexion-distraction technique using existing Current Procedural Terminology (CPT) language and codes would be the CMT codes: 98940, 98941 or 98942. As described by Dr. Cox, an originator and arguably the technique's namesake ("Cox flexion-distraction"), it is a method of chiropractic manipulation that uses long axial forces.

While many chiropractors may indeed use this method as an additional source of treatment (in addition to their own chiropractic technique) and see it as more of a "pulling" than a manipulation, it is manipulation nonetheless. The coding for this service in this manner is also substantiated by the statement and interpretation from the American Chiropractic Association (ACA), which indicates flexion-distraction is to be coded using chiropractic manipulative therapy codes.

According to the ACA, "Flexion-distraction is a Chiropractic Manipulative Technique. Per the preamble of the CMT code set (98940-98943), it is a procedure that is a form of manual treatment to influence joint and neurophysiological function. The physician work included in CMT codes was laid out in a work value survey of the chiropractic profession conducted in the spring of 1996 and included the work of flexion-distraction. The procedure is taught in the curriculum in accredited chiropractic programs and institutions. Therefore, the appropriate coding for this technique is 98940, 98941, or 98942, depending on the number of other body regions treated."

If you are billing for traction under this code and your file is audited and notes that the service being billed under traction was indeed flexion-distraction, there could be request for a refund, as that service under flexion-distraction was part of another service, namely and assuming 98940-98942 was billed that date of service. If no manipulation code was billed, it may still be refuted as the incorrect code for the service provided; however, manipulation is generally a higher-valued service and no net refund may be necessary.

Feel free to submit billing questions to Mr. Collins at . Your question may be the subject of a future column.

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