HEALTH CARE BILLING NEWS

Chiropractic Medical Coding

The primary therapeutic procedure chiropractors provide is spinal manipulation/adjustment. Generally, chiropractic service reimbursements are limited to treatment by means of manual manipulation (using the hands) of the spine for correcting a subluxation. This subluxation of the spine should be proved by x-ray or physical examination. For billing purposes, the chiropractor has to specify the level of subluxation on the claim and list it as the primarydiagnosis. The secondary diagnosis would be the neuromusculoskeletal condition necessitating the treatment. The corresponding diagnostic codes (ICD-9 codes) must be listed to substantiate medical necessity.

98940, 98941, 98942 are the chiropractic manipulative treatment (CMT) codes describing the number of spinal regions receiving the manipulation. 98943 is the single extraspinal CMT code used by chiropractors to describe manipulative services for the head, rib cage, extremities, and abdomen. For due reimbursement, chiropractors need to report these manipulations using the appropriate CPT manipulation codes.

98940 — Chiropractic manipulative treatment (CMT); spinal, one to two regions

98941 — Chiropractic manipulative treatment (CMT); spinal, three to four regions

98942 — Chiropractic manipulative treatment (CMT); spinal, five regions

98943 — Chiropractic manipulative treatment (CMT); extraspinal, one or more regions

How Are Chiropractors Reimbursed?

Chiropractors are reimbursed for their services in different ways. Medicare provides payment only for these codes, whereas there are commercial insurance companies that reimburse a global fee. In the latter case, chiropractors are allowed a certain dollar amount for each visit, irrespective of the services provided or the CPT codes billed. Chiropractors may also bill for modalities apart from the manipulation and office visit codes, these modality codes range from 97010 – 97530, which again are reimbursed by some insurance companies.

The codes differ with a new patient and an established patient-new patient billing codes range from 99201-99205 and established patient codes are from 99211-99215. Sometimes chiropractors may have to bill an E&M service along with a CMT on the same day. Chiropractors can bill a separate E&M code on occasions such as visit of a new patient, or an established patient presenting with a new injury, re-injury/recurrence, exacerbation, or for a re-evaluation to decide whether any modification in the treatment plan is required. When billing your services, your exam is to be coded correctly, and then Modifier -25 has to be added under the modifier section. This will clarify that the medical examination was a service distinct from your therapeutic manipulation procedure and therefore should be paid in addition to the adjustment. Medicare does not reimburse chiropractic maintenance therapy.

Other Services a Chiropractor May Bill

Physical medicine modalities a chiropractor may report include supervised and constant attendance modalities. Supervised modalities do not demand personal contact with the healthcare provider, and are eligible only once per date of the service. Constant attendance modalities are time based and require direct individual contact with the service provider. Chiropractors may also report therapeutic procedures; these are time based and require direct contact with the service provider.

Importance of Accurate Documentation

Accurate documentation is important if one is looking for easy and timely reimbursement. Insurance payers need to be convinced of factors such as:

• The site where service was provided

• The medical necessity and appropriateness of the diagnostic and/or therapeutic services provided

• That the services provided are all correctly reported

Proper documentation would validate the claim(s) submitted to Medicare for reimbursement of services. Chiropractors should ensure that the documentation is in keeping with the clinical descriptors and definitions contained in CPT. It should be accepted by clinicians generally as well as interpreted and applied uniformly by users throughout the country.

A Thorough Knowledge of Coding Essentials Is Vital

Experienced medical coders with expertise in inputting chiropractic codes and modifiers can be of great assistance to practicing chiropractors. They can efficiently match chiropractic ICD-9 Codes to the appropriate chiropractic CPT codes in order to prove medical necessity. They will ensure that your claims are not rejected due to incorrect coding, and enable you to get the payments due to you in a timely manner.

About the Author

Chiropractic Medical Coding – Outsource Strategies International (OSI), a leading medical coding company, delivers cost-effective chiropractic medical coding services.

Medical Billing Tips – Coding for Medicare Flu Shots

2012 General Surgery Coding Update $197.00 General Surgery Coders: Don’t spend hundreds to go to the AMA’s CPT Symposium in Chicago when we’ve got the next best thing – for much less. Save money on travel. Our conferences are available from the comfort and convenience of your own office or meeting room. Meet your specific training needs. Whether you attend a live event, load up one of our encore broadcasts, or purchase a CD or PDF transcri…

NPPs and Incident-to: Maximize Your Reimbursement the Fraud-Free Way $227.00 Whether Non-Physician Practitioners (NPPs) are in your future plans or you’re using them now, you’ve got to play by these rules to get maximum reimbursements with minimum trouble. NPPs help ease the load in busy practices, and allow practice expansion when new physicians aren’t available. But working with NPPs brings a new set of regulations that vary from situation to situation, and carrier to c…

Demystify Anesthesia Billing, CRNAs, AAs and Medical Direction Modifiers $227.00 Without proper understanding of how and when to report the correct medical direction modifiers for anesthesia, you run the risk of denials and could even wind up in court defending yourself against serious felony charges. Keep your practice in the clear by attending this essential event with anesthesia coding pro Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I. In just 1 hour, you’ll learn how…

AuditSelf – The self auditing tool for the medical professional AuditSelf is user friendly self-auditing tool for ensuring that Evaluation and Management codes that are coded and billed, are supported by the documentation in the medical record. Just enter the elements from the medical record and AuditSelf will calculate the documented level of service. The application helps medical practices answer the question: DOES THE DOCUMENATION SUPPORT THE LEVEL OF SERVI…

3M Color Coding 3/4 White Rigginig Tape $1.99 3m Color Coding 3/4″ White Rigginig Tape . Scotch(R) Colored Plastic Tapes are extra stretchy, conformable and moisture resistant. They can be used to repair, decorate, color-code or identify. These tapes should be applied to clean, dry and smooth surfaces.

3M Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Green $7.49 3m Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Green . Excellent resistance to flame, abrasion, moisture, solvents, oil, and many acids. Gives full electrical and mechanical protection. 3/4″ x 60′.

3M Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Black $7.49 3m Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Black . Excellent resistance to flame, abrasion, moisture, solvents, oil, and many acids. Gives full electrical and mechanical protection. 3/4″ x 60′.

3M Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Blue $7.49 3m Scotch #35 Vinyl Electrical Color Coding Tapes Tape, Blue . Excellent resistance to flame, abrasion, moisture, solvents, oil, and many acids. Gives full electrical and mechanical protection. 3/4″ x 60′.