1. Retention of Records

Question: How long do we need to keep old files such as EOBs, receipts, billing information, correspondence with insurance carriers, etc.? How old do the files have to be before we can safely eliminate this kind of documentation?

Answer: Financial records and medical records are governed by separate regulations. The length of retention of medical records is determined by either HIPAA or state mandates, whereas, the retention of receipts and other financial documents is not. The federal rule for retention of medical records under HIPAA is seven years; however, there may be a variation of that requirement in your state. You must follow the state requirement if it is more stringent than the federal requirement (in other words, it makes you save files longer). 

Items such as EOBs and other receipts fall under the category of financial records in which regular tax retention guidelines apply (see www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Recordkeeping). However, keep in mind, you will want to keep proof of your receipts and correspondence for as long as the insurance companies can audit your medical records. These documents are helpful during post-payment reviews. Review your payer contracts for their review limitations which are generally 3-4 years.

2. 97140 Denials

Question: I am getting denied for 97140 when I bill it with a CMT adjustment. What can I do?

Answer: The National Correct Coding edits list 97140 as a component of 98940-98942 (CMT) when performed at the same area of the body. You can use modifier -59 with 97140 when it is performed at a different area. Use a corresponding diagnosis to support the different area.

3. Exercise Equipment

Question: What code can I use for an exercise ball?

Answer: There is only one code for all exercise equipment, and that is HCPCS code A9300 – exercise equipment.

4. Coding for BioFreeze

Question: What is the code for BioFreeze?

Answer: BioFreeze falls under A9150 non-prescription drugs.

5. 97014 or G0283

Question: We have been using the code G0283 for electrical stimulation and want to make sure that is the correct code. In the past we were using code 97014. Which one is correct?

Answer: G0283 is currently the correct code to use when billing electric stimulation to Medicare and United Health Care. However, be alert to other payers who might also commence using this specific code, because it is more accurate than the general 97014 code. Monitor your payment reports.

Both codes are correct to use, depending on the payer.

6. Billing for additional insurance forms

Question: If an insurance company requests notes on a patient for a particular visit, may we charge the insurance company for those notes? Also, if we need to send the notes for a precertification, such as with Landmark Healthcare, can we charge them for the notes and processing the forms needed?

Answer: Perhaps. Code 99080 is for special reports such as insurance forms, beyond the information conveyed in the usual medical communications or standard reporting. Therefore, if the notes/copies/reports are beyond "usual/standard," then bill for them using this code. Whether or not the payers will recognize it is up to them.

7. Report of Findings

Question: We would like to start billing for report of findings using the proper documentation. We would also like to go through the past year or so and bill for all of the previous reports as well. How legal is this and is there an expiration on how far back I can bill?

Answer: “Report of Findings” is a common term used in chiropractic offices; however, there is no such term in the CPT code language. You will see in your ChiroCode DeskBook that your “report of findings” is a component of E/M Counseling. Select an appropriate E/M code based on the extent of your counseling session time, if you qualify. How far back you can go for a corrected claim depends on your state law and/or your contracts with your payers.

8. Laser therapy

Question: Is there a code for laser light therapy?

Answer: There is no accurate and current CPT code for "laser" treatment. Providers should consider the S8948 HCPCS code for "Application of a modality (requiring constant provider attendance) to one or more areas; low level laser; each 15 minutes." This is our first choice and recommendation.

Only when a payer does not use HIPAA Level II codes do we recommend using a CPT code for this therapy. From a CPT only perspective it is an unlisted service (such as 97039, 97139 or 97799). When using an unlisted CPT code, we recommend submitting a report describing the service.

9. Spinal Decompression

Question: What CPT or HCPCS code should be used when billing Spinal Decompression to insurance Payers (like Aetna, Cigna and/or Medicare)?

Answer: Many payers recognize 97012 - mechanical traction for Spinal Decompression. Other options within CPT would be to use the unlisted codes of 97039 or 97799 in the Physical Medicine Section. 97039 is an "unlisted modality" for 15 minutes of constant attendance. 97799 is for "unlisted physical medicine/rehabilitation service or procedure." However, both of these codes would need a report/explanation to the payers.

There is also S9090 within the HCPCS code sets. It is for "Vertebral axial decompression, per session." However this code is not recognized by very many payers.

10. Diagnosis Coding – 4th and 5th digit

Question: My insurance company insists that 724.3 needs a 5th digit. Should I just add a “0” to it?

Answer: No. Some payers have obsolete/incorrect information. Not all diagnosis codes are 5 digits, some are 4 and some are only 3. The term to remember is “highest specificity.” You can always verify your code is at its highest specificity by selecting it from the bold indented highest specificity column in your ChiroCode DeskBook.

11. Re-Reading X-rays

Question: My patient brought in x-rays from another office. How can I bill for re-reading them?

Answer: There are two different situations here. Are you reading them as part of the “history” component of your E/M? If so, you would use the correct level of E/M.

Are you reading the x-rays and doing a written report? If that is the case, select the appropriate x-ray code and append modifiers -26 and -77. Modifier -26 says you only did the professional component (reading the x-ray and writing report) and -77 shows that it was a repeat procedure by a different doctor.

12. Outcomes Assessment Questionnaires

Question: How often should Outcomes Assessment Questionnaires be administered for patients?

Answer: As a standard, they should be administered at the initial exam and every 30 days thereafter. Medicare considers an Outcomes Assessment Questionnaire to be current if it is 30 days old or newer. Most private payers will follow Medicare as a standard.

13. Accounts Receivable

Question: Can our office charge interest on accounts receivable if they are past due? Are there any limits? What do you recommend?

Answer: Yes, you can charge interest. The maximum percentage is usually dictated by your state. The one thing that is consistent everywhere is that interest charged must be charged to all applicable balances and to not select patients. Also, most states that we know of do require that patients be informed prior to interest being charged. For example, that interest will be charged at 5 percent for any balances that are 90 or 120 days or older.

14. 15-Minute Units

Question: How long is 15 minutes? Do I have to do 15 minutes or can I just do 8?

Answer: Medicare and many other payers use the “rule of rounding” when it comes to reporting timed services. 8-23 minutes is one unit, 23-37 is 2 units and so on. Use simple math to round to the nearest 15 minute unit.

Some payers use stricter standards of “15 minutes is 15 minutes,” with no ifs, ands, or buts, so make sure you know and understand payer policies.

If your service doesn’t meet the minimum standard then consider appending the modifier -52 for a reduced service.

15. E/M and CMT

Question: I submitted a claim for 99213 and 98942. It was denied. Is there a modifier I can use to get paid?

Answer: CMT codes 98940-98942 include routine E/M services and should not be reported separately. However, non-routine E/M services like exacerbations, re-evaluations, release of care and counseling can and should be reported by appending modifier -25 to the appropriate E/M code. We cover this in detail in the E/M section of your ChiroCode DeskBook.