Your FREE and easy resource for all things Texas workers' compensation
At a Glance:
Title:
453-02-3876-m5
Date:
February 3, 2003
Status:
Retrospective Medical Necessity

453-02-3876-m5

February 3, 2003

DECISION AND ORDER

I. INTRODUCTION

Spencer Sloane, D.C. (Provider) appealed the decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) denying reimbursement of $5,022.40 in payment for services provided to _____(Claimant) from October 9, 2000, through March 13, 2001. The treatments and services were billed under 10 different Current Procedural Technology (CPT) codes. St. Paul Guardian Insurance Company (Carrier) denied payment for four varying reasons, depending on the treatment. The Administrative Law Judge (ALJ) finds that some, but not all, of the disputed treatments should be reimbursed. Therefore, Carrier is to reimburse Provider $1,491.00.

II. PROCEDURAL HISTORY

ALJ Sharon Cloninger convened the hearing on December 3, 2002, in the William Clements Building, 300 West 15th Street, Austin, Texas. Carrier was represented by Steven M. Tipton, attorney. H. Douglas Pruett, attorney, appeared and represented Provider, who appeared by telephone. The Texas Workers’ Compensation Commission (the Commission) did not participate in the hearing. The parties did not contest notice or jurisdiction, which are addressed in the Findings of Fact and Conclusions of Law below. The hearing concluded and the record closed that same day.

III. BACKGROUND

On_____, Claimant was a dry-wall applicator employed by ____. in Dallas, Texas. On that date he sustained a compensable injurywhenhe stepped down from one level of sheet-rock to another and twisted his right ankle, causing him to lose his balance and fall onto his left knee.

Beginning September 11, 2000, Claimant was treated by Provider at the Atlantis Healthcare Clinic in Grand Prairie, Texas. Provider diagnosed Claimant to have unspecified ankle, leg, and knee sprain, and chondromalacia of patella.[1] Provider used manual procedures including myofascialrelease, joint mobilization, and manual traction, as well as supervised therapeutic exercises, to treat Claimant’s radiating pain and tenderness.

Provider referred Claimant to Ergos Work Recovery, Inc., for a functional capacity evaluation (FCE) which was conducted on November 15, 2000. (Provider’s Exhibit 1 at 101). The FCE summary shows Claimant performed below the “heavy” level job requirements of a drywall applicator, as listed in the Department of Labor’s Dictionary of Occupational Titles. (Provider’s Exhibit 1 at 103). Because Claimant could not perform at the level required by his job, he was at risk of re-injury if he returned to work. (Provider’s testimony).

On November 22, 2000, Claimant was seen by Diane Franczek, a behavioral medical consultant at Southwest Behavioral Health Services in Bedford, Texas. She found Claimant to be depressed because of his injury, and likely to benefit from health services to decrease his depression. (Provider’s Exhibit 5).

Following the FCE and the behavioral assessment, Claimant was enrolled in Provider’s work hardening program from December 8, 2000, through January 26, 2001.A second FCE conducted December 22, 2000, showed Claimant’s functional capacity to have improved from the middle of the “medium” category to being able to do everything in the “medium” category, with improvements of between 18-76 percent in strength activities overall. (Provider’s Exhibit 1 at 248).

According to Commission work status reports, Claimant was allowed to return to work with restrictions from January 29, 2001, through February 29[sic][2], 2001, and without restrictions as of March 12, 2001. (Provider’s Exhibit 6).

IV. DISCUSSION

A. Treatments and services at issue

The following treatments and services are in dispute in this proceeding and are listed by CPT code, in numerical order.[3] Included in the list is the maximum allowable reimbursement (MAR), if applicable, for each treatment or service, as listed in the Commission’s Medical Fee Guideline (MFG).

  • 97110 (Therapeutic procedures one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. MAR’$35.00 for each 15 minutes) Provider billed $105.00 per disputed date, for three units per session, for sevendates of service from October 9, 2000, through November 16, 2000, for a total of $735.00.
  • 97122 (Manual traction. MAR’$35.00) Provider billed Carrier $35.00 per session for seven treatments occurring between October 9, 2000 and November 16, 2000, for a total of $245.00.
  • 97250-59 (Myofascial release/soft tissue mobilization, one or more regions. MAR = $43.00) Provider billed Carrier $43.00 per session for seven treatments occurring from October 9, 2000, through November 16, 2000, for a total of $301.00.
  • 97265 (Joint mobilization, one or more areas, peripheral or spinal. MAR’$43.00) Provider billed Carrier $43.00 per session for seven joint mobilization treatments occurring from October 9, 2000, through November 16, 2000, for a total of $301.00.
  • 97545-WH[4] (Work hardening/conditioning: initial two hours. MAR’$ 64.00 per hour) Provider billed Carrier $51.20 per hour for two hours on nine dates from December 8, 2000, through January 26, 2001[5], and $153.60 for three hours on January 17, 2001, for a total of $1,075.20.
  • 97546-WH (work hardening, each additional hour beyond two hours. MAR’$64.00 per hour) Provider billed Carrier for additional hours of work hardening occurring on nine dates from December 8, 2001, through January 26, 2001.
  • 99090 (Analysis of information, such as ECGs, blood pressures, hematologic data, stored in computers. MAR = $108.00) Provider billed Carrier $108.00 for one analysis dated October 17, 2000.
  • 99213 (Office or outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. . . . Physicians typically spend 15 minutes face-to-face with patient. MAR’$48.00) Provider billed Carrier $48.00 per visit for seven office visits occurring from January 31, 2001, through March 13, 2001, for a total of $336.00.
  • 99213-MP[6] (Office visit: first manipulation. MAR’$48.00) Provider billed Carrier $48.00 per visit for five office visits with first manipulations occurring from October 9, 2000, through November 1, 2000, for a total of $240.00.

B. Applicable Law

Because Claimant’s compensable injury is to his knee, the Commission’s Lower Extremities Treatment Guideline (LETG) found at 28 Tex. Admin. Code (TAC) § 134.1003 applies. LETG (e)(1) sets out that the LETG reflects services that are reasonable and medically necessary for treatment of lower extremity injuries, but that some injured workers might require treatment outside the guidelines, which would require documentation of the special circumstances justifying the treatment. The LETG requires treatment of a work-related injury to be documented by the health care provider to determine the level of care to be provided and the necessity for that care. 28 TAC § 134.1003(e)(3)(B).

The Commission has adopted rules governing work hardening programs. The rules, found in the MFG, relate to, among other things, what documentation is required of work hardening providers. Work hardening is defined in the MFG at Medicine Ground Rule (MGR) (II)(E) as:

a highly structured, goal-oriented, individualized treatment program designed to maximize the ability of the persons served to return to work. Work Hardening programs are interdisciplinary in nature with a capability of addressing the functional, physical, behavioral, and vocational needs of the injured worker. Work Hardening provides a transition between management of the initial injury and return to work while addressing the issues of productivity, safety, physical tolerance, and work behaviors. Work Hardening programs use real or simulated work activities in a relevant work environment in conjunction with physical conditioning tasks. These activities are used to progressively improve the biomechanical, neuromuscular, cardiovascular/metabolic, behavioral, attitudinal, and vocational functioning of the person served.

Group therapy, as a component of work hardening, is addressed at MGR (II)(E)(2)(b), which states:

Group therapy, provided by a Qualified Mental Health Provider, is considered to be part of the Work Hardening program and shall be reimbursed at the hourly rate set for this program.

Work hardening documentation requirements are found at MGR (II)(E)(8), which states:

Daily treatment and patient response to treatment shall be documented and reviewed to ensure continued progress.

Carrier’s reasons for denial of payment

For each CPT code billed, Carrier denied payment using denial code “V,” which is used when the carrier deems the treatment to have been unnecessary, based on peer review of the treating doctor’s records by another doctor.

In addition to using denial code “V,” Carrier also denied payment for six of seven office visits billed under CPT code 99213 using denial code “U,” which is used when the insurance carrier is reducing or denying payment because the service is considered to be an unnecessary medical treatment or service.

Carrier used denial codes “A,” “F,” and “U” as well as “V” in refusing to reimburse Provider for charges billed under CPT codes 97545-WH and 97546-WH, related to Claimant’s work hardening. Denial code “A” is used when the insurance carrier is denying payment because preauthorization was not obtained. Denial code “F” is used when a carrier reduces payment according to fee guidelines.

D. Evidence and argument

Provider testified in his own behalf, and offered the 292-page certified record of the MRD proceeding and five additional documents, all of which were admitted.Carrier offered no documents and called no witnesses.

Provider’s testimony

Provider testified that active therapeutic exercise (CPT Code 97110) was provided to Claimant on an individual basis because his injury was unique, and no other patients needed to do the same exercises that he did.

He said manual traction (CPT Code 97122) must be provided one-on-one, and cannot be provided in a group setting. The procedure separates the joint surfaces to invite the flow of fluids into the joint, and to allow the elimination of toxic fluids from the joint.

He testified that myofascial release (CPT Code 97250) involves the application of direct pressure to trigger points, which are the source of inflammation and pain where muscle tissues are torn, for the elimination of toxins. The procedure must be performed one-on-one, and cannot be performed in a group setting.

He said in joint mobilization (CPT Code 97265) treatment, the provider moves the joint through its normal ranges of motion, holding the joint in a position for a specific amount of time to ensure proper healing of scar tissue. This procedure must be done one-on-one by the provider, and cannot be performed by the patient or a staff member.

Provider testified that he should be reimbursed for analysis of computer information (CPT Code 99090), because he reviewed the range of motion and muscle testing report that is stored in the computer, and made clinical changes based on that report. (Provider’s Exhibit 1 at 256, based on conclusions drawn for reports at Provider’s Exhibit 1 at 255 and 258-259).

In Provider’s opinion, Claimant’s admission to the work hardening program was medically necessary, based on the functional capacity evaluation (FCE) done November 15, 2000, and the Southwest Behavioral Health Services initial clinical assessment performed November 22, 2000. (Provider’s Exhibit 1 at 101, and Provider’s Exhibit 5). The assessment does not identify any psychological reason to prevent Claimant from participating in work hardening. The recommendation is that Claimant needs behavior modification, which is provided in work hardening. Provider testified that no documentation of the amount of time spent in each work hardening activity is required. He said an FCE conducted December 22, 2000Bafter two weeks of work hardening-demonstrated functional improvement. (Provider’s Exhibit 1 at 102-104 and 248-249). Provider testified that although Claimant had improved, he was not released from work hardening because Provider had received pre-authorization from Carrier for two more weeks of work hardening, based on Claimant’s improvement up to December 22, 2000. Claimant was released to work with restrictions on January 29, 2001.

Regarding group therapy provided during work hardening, Provider used Southwest Behavioral Health Services, but does not know how many times Claimant attended sessions or what the session topics were, because that information was not provided to him.

V. ANALYSIS AND CONCLUSION

A. Evidence supports reimbursement for therapeutic services billed under CPT code 97110 (supervised therapeutic exercises), and denied under payment exception code “V”

Provider billed Carrierfor three 15-minute units of therapy at $35.00 per unit per visit, or $105.00 per session, for a total of $735.00 for seven sessions between October 9, 2000, and November 16, 2000. The documentation indicates that all therapeutic exercise sessions were supervised, and Provider testified that the sessions were one-on-one. Accordingly, the ALJ orders payment of $735.00 for treatment billed under this CPT Code.

B. Documentation supports reimbursement for treatments and/or services billed underCPT codes 97122, 97250-59and 97265, and denied by Carrier under payment exception code “V”

Carrier should reimburse Provider $245.00 for seven manual traction treatments (CPT code 97122) billed at $35.00 each, which are supported by documentation in the record. Documentation supports payment to Provider of $301.00 for seven treatments at $43.00 each using myofascial release and billed under CPT code 97250-59.The medical records in this case support payment for joint mobilization procedures (CPT code 97265) performed on the seven disputed dates, at $43.00 each, so Carrier is to reimburse Provider $301.00 for those treatments. None of these treatments could have occurred in a group setting and must be provided one-on-one. Total reimbursement for the treatment provided under the aforementioned CPT codes totals $847.00.

C. Documentation does not support reimbursement for charges billed under CPT codes 97545-WH and 97546-WH and denied by Carrier under payment exception codes “A,” “F”and “V”

Provider billed Carrier amounts varying from $0 to $153.60 for the initial two hours of work hardening for each of eightdates of service occurring from December 8, 2000, through January 26, 2001, for a total of $972.80. Provider billed Carrier $1,689.60 for additional hours of work hardening occurring onthose same dates of service, plus one more, for a total of $1,689.60. There is no evidence that Claimant participated in group therapy, a component of work hardening, on any of the disputed dates of service. See Medicine Ground Rule (II)(E)(2)(b). Thus, the criteria of work hardening was not met, and reimbursement is denied.

D. Documentation and testimony support reimbursement for treatments and/or services billed under99090, and denied by Carrier under payment exception code “V”

There is nothing in the documentation to support that analysis of information stored in a computer occurred at any time, including October 17, 2000, the disputed dates of service, except in Provider’s bill to Carrier. (Provider’s Exhibit 1 at 21). However, Provider testified that he reviewed the muscle testing and range of motion report that is stored on computer and made clinical changes based on that report. Therefore, Provider is entitled to reimbursement $108.00 from Carrier for charges billed underCPT code 99090.

E. Documentation does not support reimbursement for office visits billed under CPT code 99213, all of which were denied under “V” and six of seven of which were also denied under “U”

Provider billed Carrier $48.00 each under CPT code 99213 for seven office visits occurring from January 31, 2001, through March 13, 2001, for a total of $336.00.According to the MFG, an office visit can only be billed if two of the three elements are satisfied: an expanded problem focused

history, an expanded problem focused examination, or medical decision making of low complexity. The evidence in this case does not indicate that the requirements of CPT code 99213 were met, so reimbursement for services billed under this CPT code should be denied.

F. Documentation does not support reimbursement for office visits with first manipulation billed under CPT code 99213-MP, and denied under “V”

Provider billed Carrier $48.00 apiece, or a total of $240.00, for five office visits with first manipulations occurring from October 9, 2000, through November 1, 2000. The dates of service do not overlap with dates of service billed under CPT code 99213, above. However, the documentation does not support the requirements of CPT code 99213, nor does it state what first manipulation occurred on these visits. The ALJ finds the documentation to be inadequate to support payment for this treatment, and the request for reimbursement of $240.00 should be denied.

G. Conclusion

Provider met its burden of proof in showing that reimbursement should be ordered for CPT codes 97110 (therapeutic exercises) in the amount of $735.00, 97122 (manual traction) in the amount of $245.00, 97250-59 (myofascial release) in the amount of $301.00,97265 (jointmobilization)in the amount of $301.00,and 99090 (analysis of information stored in computer) in the amount of $108.00, Accordingly, the ALJ orders a total reimbursement of $1,491.00.

Provider withdrew his request for reimbursement of charges billed under CPT code 99082 (unusual travel). The evidence presented in this case does not support reimbursement for services and treatments billed under CPT codes99213 (office visits), 99213-MP (office visits with first manipulation), 97545-WH (work hardening: initial two hours)or 97546-WH(work hardening: additional hours). Therefore, reimbursement for those charges is not warranted.

VII. FINDINGS OF FACT


  1. _____.(Claimant) sustained a compensable work-related injury on_____, while employed with _____ in Dallas, Texas, whose workers’ compensation insurance carrier was St. Paul Guardian Insurance Company (Carrier).
  2. Spencer Sloane, D.C., (Provider) began treating Claimant on September 11, 2000, and diagnosed his compensable injury to be unspecified knee and ankle sprain, and chondromalacia of patella.
  3. Provider used manual procedures including myofascial release, joint mobilization, manual traction, and supervised therapeutic exercises, to treat Claimant’s compensable injury.
  4. Provider referred Claimant to Ergos Work Recovery, Inc., for a functional capacity evaluation (FCE), which was conducted on November 15, 2000.
  5. The FCE evaluation summary stated Claimant's functional capacity was below the level necessary for him to perform his job, as set forth in the Department of Labor’s Dictionary of Occupational Titles.
  6. On November 22, 2000, Claimant was evaluated at Southwest Behavioral Health Services, and found to have behavioral issues that could be addressed in a work hardening program.
  7. Following the FCE and behavioral assessment, Claimant enrolled in Provider’s work hardening program from December 8, 2000, through January 26, 2001.
  8. Provider sought reimbursement of $5,022.40 from Carrier for services rendered to Claimant, and billed under the following CPT codes:
    • 97110 (Therapeutic procedures one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. MAR’$35.00 for each 15 minutes) Provider billed $105.00 per disputed date, or for three units per session, for sevendates of service from October 9, 2000, through November 16, 2000, for a total of $735.00.
    • 97122 (Manual traction. MAR’$35.00) Provider billed Carrier $35.00 per session for seven treatments occurring between October 9, 2000 and November 16, 2000, for a total of $245.00.
    • 97250-59 (Myofascial release/soft tissue mobilization, one or more regions. MAR = $43.00) Provider billed Carrier $43.00 per session for seven treatments occurring from October 9, 2000, through November 16, 2000, for a total of $301.00.
    • 97265 (Joint mobilization, one or more areas, peripheral or spinal. MAR’$43.00) Provider billed Carrier $43.00 per session for seven joint mobilizations occurring from October 9, 2000, through November 16, 2000, for a total of $301.00.
    • 97545-WH[7] (Work hardening/conditioning: initial two hours. MAR’$ 64.00 per hour) Provider billed Carrier $51.20 per hour for up to three hours on each of eight dates of service occurring from December 8, 2000 through January 26, 2001.
    • 97546-WH (Work hardening, each additional hour beyond two hours. MAR’$64.00 per hour) Provider billed Carrier $6,336.00 for additional hours of work hardening occurring on nine dates from December 8, 2000 through January 26, 2001.
    • 99082 (Unusual travel such as transportation and escort of patient. Requires documentation of procedure so there is no MAR). Provider billed Carrier $ 51.00 for three occasions at $17.00 each of unusual travel occurring on October 9, 2000, November 30, 2000, and December 11, 2000.
    • 99090 (Analysis of information, such as ECGs, blood pressures, hematologic data, stored in computers. MAR = $108.00) Provider billed Carrier $108.00 for one analysis dated October 17, 2000.
    • 99213 (Office or outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity. . . . Physicians typically spend 15 minutes face-to-face with patient. MAR’$48.00) Provider billed Carrier $48.00 per visit for seven office visits occurring from January 31, 2001, through March 13, 2001.
    • 99213-MP[8] (Office visit: first manipulation. MAR’$48.00) Provider billed Carrier $48.00 per visit for five office visits with first manipulations occurring from October 9, 2000, through November 1, 2000.
  9. Carrier denied reimbursement for the treatments and services in Finding of Fact No. 8.
  10. Therapeutic services billed under CPT code 97110 were provided in a one-on-one setting, on seven dates of service.
  11. Documentation for five office visits billed under CPT code 99213 at $48.00 apiece does not set out that two of the following three services were provided during each visit: an expanded problem focused history, an expanded problem focused examination, or medical decision making of low complexity.
  12. Documentation for office visits billed under CPT code 99213-MP does not set out two of the following three services were provided during each visit: an expanded problem focused history, an expanded problem focused examination, or medical decision making of low complexity. The documentation does not state how the “first manipulation” modifier of this code was met.
  13. On October 17, 2000, Provider analyzed information stored in a computer.
  14. Provider treated Claimant with myofascial release billed under CPT code 97250-59 on seven dates between October 9, 2000, and November 16, 2000.
  15. Provider treated Claimant with manual traction (CPT code 97122) on seven dates between October 9, 2000, and November 16, 2000.
  16. Provider treated Claimant with joint mobilization(CPT code 97265)on seven dates of service from October 9, 2000, through November 16, 2000.
  17. The work hardening documentation contains no information regarding Claimant’s participation in group therapy, a required component of work hardening.
  18. On October 24, 2001, Provider filed a request for medical dispute resolution with the Texas Workers’ Compensation Commission’s Medical Review Division (MRD), asking for reimbursement of $5,022.40 for the above-described services.
  19. On July 3, 2002, the MRD denied reimbursement of the disputed $5,022.40.
  20. On July 15, 2002, Provider appealed the MRD’s decision to the State Office of Administrative Hearings (SOAH).
  21. On August 9, 2002, notice of the hearing was mailed to Carrier, Provider, and the Commission’s APA Litigation Section. The hearing notice informed the parties of the matter to be determined, the right to appear and be represented, the time and place of the hearing, and the statues and rules involved.
  22. On December 3, 2002, SOAH Administrative Law Judge Sharon Cloninger convened the hearing in the William Clements Building, Fourth Floor, 300 West 15th Street, Austin, Texas. Provider appeared by telephone and was represented by counsel. Carrier’s representative attended the hearing. The hearing concluded and the record closed that same day.

VIII. CONCLUSIONS OF LAW

  1. The Texas Workers’ Compensation Commission (Commission) has jurisdiction to decide the issues presented in this case, pursuant to the Texas Workers’ Compensation Act (the Act), Tex. Labor Code Ann. §413.031.
  2. The State Office of Administrative Hearings has jurisdiction over matters related to the hearing in this case, including the authority to issue a decision and order, pursuant to Tex. Labor Code Ann. §413.031(d) and Tex. Gov’t Code Ann. ch. 2003.
  3. Provider timely filed notice of appeal of the decision of TWCC’s Medical Review Division (MRD), as specified in 28 Tex. Admin. Code (TAC) § 148.3.
  4. Proper and timely notice of the hearing was provided in accordance with Tex. Gov’t Code Ann. § 2001.052 and 28 TAC §48.4(b).
  5. As the party appealing the MRD decision, Provider had the burden of proving the case by a preponderance of the evidence, pursuant to 28 TAC §148.21(h) and (i).
  6. The Lower Extremities Treatment Guideline (LETG) found at 28 TAC § 134.1003 applies to treatment of Claimant’s compensable injury.
  7. Based on the above Findings of Fact, Provider failed to meet documentation requirements of for CPT codes 99082 (unusual travel),99213 (office visits), 99213-MP (office visit withfirst manipulation),and 97545-WH (work hardening, first two hours) and 97546-WH (work hardening, additional hours),and should not be reimbursed for those services and treatments.
  8. Based on the above Findings of Fact and Conclusions of Law, Provider met its burden of proof regarding payment for therapeutic exercises billed under CPT code 97110.
  9. Based on the above Findings of Fact and Conclusions of Law, Provider met its burden of proof for CPT codes 97250-59 (myofascial release), 97122 (manual traction) and 97265 (joint mobilization).
  10. Based on the above Findings of Fact and Conclusions of Law, Provider met its burden of proof for charges billed under CPT code 99090 (analysis of information stored in a computer).
  11. Based on the above Findings of Fact and Conclusions of Law, Provider’s appeal should be granted in part and denied in part, and Carrier should reimburse Provider $1,491.00.

ORDER

Provider had the burden of proving its case at the SOAH hearing. Provider proved its case in part. Therefore, IT IS ORDERED THAT St. Paul Guardian Insurance Company is to reimburse Spencer Sloane, D.C., $1,491.00 for the disputed services and treatments.

Signed this 3rd day of February, 2003.

SHARON CLONINGER
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

  1. Chondromalacia patellae is pain and crepitus over the anterior aspect of the knee, particularly in flexion, with softening of the cartilage on the articular surface of the patella and in later stages, effusion. Dorland’s Illustrated Medical Dictionary, 28th Edition, 1994, p. 321.
  2. There was no February 29th in 2001.
  3. At the hearing on the merits, Provider withdrew its request for reimbursement for charges billed under CPT code 99082 (unusual travel such as transportation and escort of patient) with dates of service of October 9, 2000, November 30, 2000, and December 11, 2000.
  4. The WH modifier is used with CPT Codes 97545 and 97546 when work hardening, as opposed to work conditioning, is performed. (MFG at 44).
  5. The MRD considered nine dates of work hardening, from December 8, 2000 through January 26, 2001. At the hearing on the merits, the parties stipulated that the work hardening services provided January 15, 2001, through January 26, 2001, had been pre-authorized, leaving December 8, 2000, and December 11, 2000, as the only dates of service of service for which medical necessity must be shown. However, for reimbursement to occur, evidence must support that the work hardening requirements as set out in the Commission’s Medicine Ground Rules were met on the disputed dates of service.
  6. The MP modifier is added to the evaluation and management code when the first manipulation for the visit is performed. (MFG at 43).
  7. The WH modifier is used with CPT Codes 97545 and 97546 when work hardening, as opposed to work conditioning, is performed. (MFG at 44).
  8. The MP modifier is added to the evaluation and management code when the first manipulation for the visit is performed. (MFG at 43).
End of Document
Top