How to Properly Bill for Flexion Distraction

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

The coding of this service is often confused and misunderstood. I think mainly because of the term used to describe it “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 language and codes would be the CMT codes, 98940, 98941, or 98942. As described by Dr. Cox, an originator and arguably the technique’s name sake “Cox Flexion-Distraction” it is a method of chiropractic manipulation that uses a long axial forces.

While many chiropractors may indeed use this method as an additional source of treatment to their own chiropractic technique and see it as more a method of “traction” than a manipulation, it is manipulation none the less. The coding for this service in this manner is also substantiated by the statement and interpretation from the American Chiropractic Association (ACA), which too indicates flexion distraction, is to be coded under chiropractic manipulative therapy codes.
Per 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”.

Therefore if billing for traction under this code and your file was audited and noted 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.