by Wyn Staheli, Director of Research
April 29th, 2019
Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of the spinal regions. Therefore, your documentation MUST reflect that fact. This means that your documentation must include the fact that the patient had complaints in all five regions. Historically code 98942 is frequently targeted by auditors because many providers adjust full spine without having documentation which supports and establishes the medical necessity for all five regions. Essentially, you must have documentation which addresses each area with a patient complaint, relevant objective findings, a clear plan for resolution, and demonstrable progress.
It is always a good idea to conduct your own internal audit on a regular basis. Appendix D of the 2019 ChiroCode DeskBook includes information on how to do this annual task.