Chiropractic Coding & Billing Articles

How much interaction do you have with providers in your coding role? This question is interesting in that there are many coding jobs that require day-to-day interaction with providers a ...

Knowing when to report symptom codes has always been a conundrum for coders at one point or another in their career but with the complex EHRs and coding systems used today, requiring a ...

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 ...

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 ...

One of the more common forms of tenosynovitis is when the sheath that covers the two tendons connecting the forearm muscles to the bones of the thumb and wrist becomes inflamed from ove ...

The standardization of medical records offers numerous benefits for healthcare systems, providers, and patients. By ensuring interoperability, improved workflows, better patient safety, ...

Healthcare is witnessing a digital revolution of sorts with advancements in technology that seem to transform many aspects of patient care. An example of this transformation involves th ...

UnitedHealthcare has issued a notice that there is a new Manipulation Commercial Payer policy which will become effective on July 1, 2023. Learn about the changes to the “Coverage Rat ...

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 ...

Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride and we now have two new twists to this exciting ride. Buckle up and let’s look at how this ch ...

Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and theref ...

How did you do? Take a look at the Improper Payments Report and see where there can be improvement in your practice. ...

New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective o ...

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 ...

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. ...

New coronavirus antigen testing codes announced. These are effective immediately. ...

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? ...

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 ...

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? ...

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. ...

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 ...

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

G8730, when is it required. Many G codes are still active and are required for non-quality reporting. ...

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 ...

Q: I have a payor who is denying modalities, claiming that they are “excessive”. At a single encounter I billed for: 98940- Chiropractic manipulative treatment (CMT); spinal, 1 ...

Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which ...

Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about ...

Question Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's ...

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 ...

Questions regarding using modifiers when billing CMT and non-covered codes to Medicare. We have used AT (Active) and GA (signed ABN) when billing active care for CMT codes 98940-98942 ( ...

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 ...

Is it necessary to use the modifier NU for all supplies? or is NU part of the code itself? Where should the NU be noted on the 1500 form? ...

What is new for Chiropractors for 2018? See for yourself the new ICD-10 and CPT Codes. ...

Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare? ...

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 ...

Documentation Solutions, a quick tip video by Dr Gwilliam. ...

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

A locum tenens provider is one that works in the place of the regular physician for a short duration of time. Guideline typically allows this time period to be a 60 day maximum, when a ...

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 ...

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: How should I bill for face-to-face Counseling time spent with the patient? ...

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

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 ...

This code is not reserved for stroke recovery, but it could certainly apply when treating some symptoms of a stroke. It is often used for many other conditions so long as medical necess ...

We are using the ABN for non-covered services (such as therapy codes) when the patient is under active care. We are also using the ABN for CMT codes when the patient is under maintenanc ...

Is there a way to bill out for Class 4 deep tissue hot laser treatments? ...

What is the ICD-10 code for acetabular labral tear? ...

Question: When using code 99050 (after hours), do I just add a amount, example $25.00, to our normal total charges for that patients visit? ...

What is MIPS and what now? ...

Watch Another quick tip from the ChiroCode HelpDesk - Plain Film Xray Penalty 2017. Even though this news comes from Medicare, who does not reimburse chiropractic physicians for x-rays, ...

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: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the ...

Q: What is the proper code for "Lumbar Decompression? ...

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

Generating a differential diagnosis — that is, developing a list of the possible conditions that might produce a patient's symptoms and signs — is an important part of clinical reas ...

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 ...

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

(from page 210 in chapter 3.5 of the 2017 DeskBook) One of the biggest problems providers face when audited is that many services are deemed not medically necessary and are routinely de ...

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 ...

There are thousands of code changes going into effect on October 1. Here is a list of the the 70 or so that are most relevant to chiropractors. ...

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 ...

The 2016 Chirocode Deskbook offers advice on waivers! It is improper and illegal to waive co-payments and/or deductibles. For this reason, if you wish to offer some sort of assistance ...

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 ...

The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List: ...

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: ...

Don’t code radiculitis (M54.1-) separately if you use the fourth character of “1”, “with radiculopathy”, for the disc disorders (M50.1- or M51.1-). It is already included in t ...

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 ...

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? ...

Here at ChiroCode we often get to look at doctor records and provide advice on ways to improve them. One of the main issues is lack of functional progress to establish medical necessit ...

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? ...

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 ...

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

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 ...

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 ...

What is the ABN form used for? The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that th ...

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 ...

Muscle and Range of Motion Testing guidelines have recently been clarified in the AMA CPT Assistant. Muslce Testing Table included ...