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Muscle Testing Codes Removed for 2020

In the billing world, a new year means new codes. It also means that we left some codes behind. There were a few changes this year to muscle testing codes that may have an impact on chiropractic offices, especially those that focus on sports medicine, physiotherapy, or neurology. CPT ® codes 95831-95833: Manual Muscle Testing have been removed. If you haven’t used those codes before, no worries because they required extensive criteria that had to be met in order to bill them. Under those circumstances, muscle testing performed to this extent would only have been applicable for a known impairment or for documenting functional loss as a result of a personal injury or Workers Compensation claim.

Muscle testing is a component of an Evaluation and Management (E/M) service if it is done in conjunction with a patient history, exam, and if the provider’s medical decision-making processes have all been well documented for that date of service. The results may be used to determine the patient’s diagnosis and can also help to establish specific, measurable, and functional treatment goals.

When the necessary criteria is not met, you may find that payers bundle the muscle testing with the chiropractic manipulation (98940-98943). These manipulation codes include a pre- and/or post manipulation assessment of the patient encompassing examination and palpation of the affected areas. This includes the assessment of muscle strength, range of motion, flexibility, and endurance and must be monitored from visit to visit.

CPT ® code 97750-Physical Performance Testing/Measurement is not the same as manual muscle testing

This service includes isokinetic testing for assessing the combination of strength, endurance and power, functional capacity testing, and specific tests and measures related to balance. This is a time-based evaluation code and therefore proper documentation must include the time used for preparing the patient for the evaluation, the testing itself, and any post-evaluation instructions given to the patient. It is used for evaluations such as function movement screens and impairment rating testing.

Now is the time to double-check your billing system

Make sure that codes 95831-95833 have been deactivated to ensure they will not be used in any claims submitted after December 31, 2019. Even though manual muscle testing is no longer a separately billable service, it does not mean that providers should stop performing these evaluations. The information that is learned from muscle testing is vital to finding the correct diagnosis, evaluating a patient’s progress, and supporting the medical necessity of the other services provided by your office.

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Dr. Karen Sedore has over 10 years of experience working in the chiropractic profession. She began as a manager specializing in billing and medical necessity as well as taking on chiropractic assistant responsibilities so that she could be more involved with patient care. She also has experience with income tax preparation and has helped hundreds of families and small businesses with tax planning. In 2016, Dr. Sedore received her doctorate in Chiropractic from National University of Health Sciences. She joined KMC University in 2017 and assists doctors and their staff in her current role as a Membership Advisor.

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