Chiropractic Coding & Billing Articles

How do we know which codes a payer will allow? The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to ...

Our team is frequently asked if it is legal for chiropractic offices to offer coupons or Groupons. We’re not allowed, as a profession, to dramatically discount our services, offer fre ...

97110, Therapeutic Exercises, is one of the most commonly used CPT codes for Chiropractors. Unfortunately it is also misunderstood and misused far too often. For instance, did you kno ...

It’s that time of year again, the ICD-10-CM codes for fiscal year 2024 are out so it’s time to take a look at these changes. Of all the hundreds of changes, the following could be o ...

Coders often see conditions that seem to always be reported together. Diabetic patients tend to develop other conditions as the diabetes continues to progress instead of improving. Comb ...

The second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ...

There were several changes to the ICD-10-CM codeset for 2023 which went into effect October 1, 2023 and could impact chiropractic. At the time of publication, it was unknown how payers ...

When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equi ...

Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different ...

Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing o ...

This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The pr ...

October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new cod ...

COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes. ...

On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more informat ...

Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several case ...

Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue ...

Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better rei ...

Question:  It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the pat ...

If you haven’t reviewed your state guidelines or taken a recent look at third-party payer policies on unproven, investigational or experimental procedures, now is the perfect time to ...

The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and b ...

Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat ...

The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and man ...

Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem. ...

Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a ...

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the sam ...

Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic ...

The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official cod ...

You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-co ...

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calcula ...

 CEU’s are now available for the following Webinars:        Practice Risk Areas, Presented by Brandy Brimhall   (1 CEU)        Secrets of Chiropractic Documentation, Pre ...

There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to ...

Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have ...

Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the ...

Q: In order to code carpal tunnel syndrome G56.01 or G56.02, does there need to be documentation that nerve conduction (EMG testing) has been performed to confirm the diagnosis? ...

Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically r ...

Coding tips regarding Annual Wellness Visit and Health Risk Assessments ...

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did ...

While scanning my news feed this morning, a few alarming words caught my eye: "Opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since the epidemic began in ...

Q. Is there a modifier that can be added on to CPT codes to show we performed the service even though they are bundled charges or Medicare doesn't pay for them? For example 97140 billed ...

Q: An insurer told me that chiropractors cannot bill 99204 or 99214 because those exams "require a level of decision making that would typically only occur in an emergency room." Is thi ...

The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the am ...

The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins ...

A chiropractor recently contacted ChiroCode and told us that a payer claims that 97140 manual therapy and 97112 neuromuscular re-education are not separately billable from a chiroprac ...

In some places, the ICD-10-CM code set uses words we think we are familiar with. However, a review of the guidelines shows that some of these words have very specific definitions. Her ...

Q: We cannot find codes to identify the left or right side of the spine, such as with low back pain.  Do we add digits 1 or 2 to the code to clarify left or right? A: No.  C ...

Chiropractic’s favorite word finally gets its due in ICD-10-CM…or does it? There is a word that has long been held as sacred to the Chiropractic profession.  It is t ...

Many specialties, including chiropractors, perform services that may be deemed "experimental, investigational and unproven."  Individual payer coverage determinations, as well as state ...

Unlike MDs and DOs, chiropractors may not opt out of Medicare. When it comes to Medicare, providers and patients alike feel like beating their heads against the wall. Signing up to b ...

One of the hardest parts when reviewing a medical record for coding or auditing is the determination of what conditions were addressed. Any condition that is taking into account or affe ...

Your 2016 ICD-10-CM Coding for Chiropractic is a lot more useful than you might know. Most are familiar with the Anatomic Diagnosis Code List - always a ChiroCode favorite. Well, ...

Ever wondered how to code for wellness visits. Even though they are typically not billed to third parties, there is a right way to record these kinds of encounters. ...

Occasionally providers are faced with the need to assess the option of making a voluntary disclosure to the government. Here are steps that every provider should consider before disclo ...

ICD-10-CM will be unfrozen October 1, 2016. Will the updates make a big difference? Or are they minor? Find out in this short article. ...

Coding for a reduced cervical curve is a little tricky in ICD-10. This article explores the choices and issues around this diagnosis. ...

What's the difference between a physician, an other qualified healthcare professional, clinical staff and individual. ...

Palmetto GBA (Railroad Medicare) recently released the results of their “Widespread Review of Chiropractic Services for the first quarter of FY 2016” and while the overall charge de ...

The ChiroCode DeskBook is updated annually to reflect the most current information available and necessary for chiropractic practices.  The DeskBook is most commonly used for the pr ...

Stop losing hard-earned dollars. Too often, dollars are left on the table at billing time. Adjunctive codes for associated services should be added when they are appropriate. Here are a ...

Commonly Asked Questions: 1. Retention of Records 2. 97140 Denials 3. Exercise Equipment 4. Coding for BioFreeze 5. 97014 or G0283 6. Billing for additional insurance forms 7. Report of ...

What is a Gap Analysis? A Gap Analysis is a process by which a practice conducts a baseline assessment of the company's coding, billing, operations, and business practices. The objectiv ...

Audits are on the rise and the last you want to do is get tangled up in a fight over money you have already been paid. A smart chiropractor will audit himself to make sure there is litt ...

Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Cha ...

Providers work with many different groups and many of them have some interaction with Protected Health Information (PHI). In an effort to help us understand who qualifies as Business As ...