Chiropractic Coding & Billing Articles

Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working dia ...

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 ...

hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e. ...

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 ...

Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary? ...

Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters? ...

Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until Au ...

Question: Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services?  Answer: While the answer to this is yes, it is essential to understand ...

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 ...

Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today? ...

For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a ...

Question  We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance ...

On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the follow ...

Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors ...

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. ...

Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more ...

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 ...

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 ...

As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identif ...

In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255). ...

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 ...

The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medi ...

It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them? ...

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 ...

CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Provid ...

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 ...

Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered ...

The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not ...

A number of patients now have high deductible plans. Sometimes, deductibles can be $5000 or $10,000. My payer contract states that I must submit all claims to insurance for covered serv ...

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 ...

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 ...

What is the definition of Office Visit? Can It be billed with a Chiropractic Treatment? What about using code 99123 E&M code for office visits? Can we bill of office visits even though ...

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 ...

Question In our office when the doctor initially sees a new patient, we bill a new patient code. (99201, 99202, 99203, or 99204) At that time, the doctor gives the patient an X-ray scr ...

Topic: Electrical Stimulation (EMS) Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation (EMS) by stating that "according ODG electrical stimulati ...

My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a g ...

Question: Our claims are being rejected. We think it is related to our diagnosis codes. What is the reason for this? ...

Identity theft has become a major problem in the United States. As a prevention measure, the Centers for Medicare& Medicaid Services (CMS) is readying a fraud prevention initiative that ...

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 ...

Q: If a patient is treated with chiropractic manipulation and it is clinically appropriate but doesn't qualify as medically necessary care, what is the proper way to communicate this wh ...

We have been leaving box 14 on the 1500 claim form blank for Medicare claims and are getting denials. Could this be why? ...

What do you do when you are continually getting denials when billing office visit E/M code 99213-25 along with a CMT on dates that we do re-exams? What do you do when an appeal does not ...

Are you having a difficult time getting reimbursed? Are claims being denied because the insurance classifies everything as maintenance? ...

Physician referrals -- When can we bill a consult code? If we do not have the referral on our referral pad can we bill the consult code? ...

What are the best diagnosis codes for E-stim? ...

Question: The Doctor says he was told by a billing company a few years ago to avoid the 97112. So he has been doing 97110 instead. They do the items listed in 97110, but often some of ...

In the case of a patient who has multiple plans, which plan is primary and which is secondary? ...

When to update Box 14 on the CMS 1500 claim form. ...

ICD-10-CM changes for 2017 include 1,974 new codes, 311 deleted codes, and 425 revised codes. Chiropractors, fortunately, are only affected by about 70 of these changes. And none of the ...

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 ...

97010 is a service that is commonly not covered by payers or if it is covered, reimbursement is very minimal. This is due to a few reasons: ...

When a claim has been determined to be paid more than the allowed amount, it is considered an overpayment. The action to be taken depends on how the overpayment is discovered. This arti ...

Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes? ...

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 ...

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. ...

Are there more specific codes for supplies rather than using 99070? ...

What is the best way to handle denials? ...

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

How do you code for a bilateral condition, such as sciatica? ...

Question: How do we know which codes a payer will allow? ...

Chapter 20 External Causes of Morbidity includes codes from V00 to Y99. They were greatly expanded in ICD-10-CM. ...

The Centers for Medicare & Medicaid Services (CMS) has further defined Chiropractic Maintenance Therapy. Section 2251.3 of the Medicare Carriers Manual (MCM) has been ame ...

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 ...

The -GP modifier needs to be appended to physio-therapy codes when submitting Medicare claims. However, be aware of differing policies for different types of payers. Chiropractors typic ...