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Chiropractic Topics Page
2021 Chiropractic Cheat SheetOrder yours today! News and Important InformationIntersegmental Traction — What’s Happening with Roller Tables? 2021-05-20 ICD-10-CM 2021 Codes for your Specialty Acupuncture Clarification, 2020-02-20 Medicare Begins Covering Acupuncture Services, 2020-02-19 ImagesCode SetsICD-10-CM CodesICD-10-CM Diagnosis Codes CPT CodesCPT Procedure Codes Find-A-Code's Tools & ResourcesClick-A-DexFor quick drill-down and easy code selection. Build-A-CodeStep-by-step coding from all major code sets. NCCI Edits ValidatorValidate using NCCI edits for errors in code selection. Pro Fee CalculatorVerify Medicare Reimbursement and UCR Fees for Professional Services State Chiropractic AssociationsState Chiropractic Associations Chiropractic Topic PagesAuditingChiropractic Auditing Articles & Resources Claims ProcessingChiropractic Claims Processing Articles & Resources ComplianceChiropractic Compliance Articles & Resources DocumentationChiropractic Documentation Articles & Resources EHRChiropractic EHR Articles & Resources MedicareChiropractic Medicare Articles & Resources Procedure CodingChiropractic Procedure Coding Articles & Resources Diagnostic CodingChiropractic Diagnostic Coding Articles & Resources Additional Links and ResourcesGeneral Coverage and SubluxationNoridian - Chiropractic General Coverage and Subluxation Noridian: Chiropractic ResourcesNoridian JE Part B Chiropractic Resources Chiropractic Services Fact SheetThis Fact Sheet is for informational purposes only and is not intended to guarantee payment for services... Drugs and Biologicals Pub-100 Ch 17Drugs and Biologicals Pub-100 Ch 17 Billing Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations Select the title to see a summary and a link to the full article. October 4th, 2021 Watch out for New ICD-10-CM CodesBy Wyn Staheli, Director of Research | Published October 4th, 2021 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 on October 1, 2021. March 16th, 2021 ICD-10-CM 2021 Codes for your SpecialtyBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 16th, 2021
18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Code: Description:R51.0 Headache with orthostatic component, not elsewhere classifiedR51.9 Headache, unspecifiedR74.01 Elevation of levels of liver transaminase levelsR74.02 ... October 7th, 2020 Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) ProgramBy Wyn Staheli, Director of Research | Published October 7th, 2020 To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB. September 29th, 2020 ICD-10-CM 2021 Coding Updates for ChiropracticBy Wyn Staheli, Director of Research | Published September 29th, 2020 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 codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes. June 3rd, 2020 Watch for Payer Telehealth Coverage ChangesBy Wyn Staheli, Director of Research | Published June 3rd, 2020 As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage. May 12th, 2020 Getting Your Practice Back on TrackBy Wyn Staheli, Director of Research | Published May 12th, 2020 As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement. April 13th, 2020 COVID-19 Chiropractic ResourcesBy Wyn Staheli, Director of Research | Published April 13th, 2020 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. April 7th, 2020 More Telehealth Changes Announced by CMS Chiropractic Offices Should Know AboutBy Wyn Staheli, Director of Research | Published April 7th, 2020 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 information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar. March 31st, 2020 CMS-Coverage for Therapeutic Shoes for Individuals with DiabetesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 31st, 2020 Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ... March 25th, 2020 COVID-19: Cybercrime, Telehealth, and CodingBy Wyn Staheli, Director of Research | Published March 25th, 2020 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 cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ... February 20th, 2020 Acupuncture ClarificationBy Wyn Staheli, Director of Research | Published February 20th, 2020 In the ChiroCode Newsletter released yesterday regarding Medicare coverage of acupuncture, one sentence in particular has let to some confusion. Read more about it here. February 19th, 2020 Medicare Begins Covering Acupuncture ServicesBy Wyn Staheli, Director of Research | Published February 19th, 2020 Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules. February 19th, 2020 Q/A: Did Noridian Stop Covering the M99.0- Codes?By Wyn Staheli, Director of Research | Published February 19th, 2020 Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy? January 14th, 2020 Billing for Telemedicine in ChiropracticBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 14th, 2020 Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care. January 14th, 2020 Q/A: Can Chiropractors Bill 99211?By Wyn Staheli, Director of Research | Published January 14th, 2020 Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code... December 3rd, 2019 Answering the Question: Does my Insurance Cover Chiropractic Care?By Wyn Staheli, Director of Research | Published December 3rd, 2019 - Last Review/Update December 4th, 2019 The question "Does my insurance cover chiropractic care" is the ongoing question chiropractic offices have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer so there isn't one easy answer. November 19th, 2019 Changes to Portable X-Ray RequirementsBy Wyn Staheli, Director of Research | Published November 19th, 2019 On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law. August 16th, 2019 Medical ID TheftBy Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019 Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ... August 9th, 2019 The OIG Work Plan: What Is It and Why Should I Care?By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019 The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ... July 29th, 2019 The Role of Chiropractic in Value Based Payment SystemsBy Wyn Staheli, Director of Research | Published July 29th, 2019 Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition. July 22nd, 2019 Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?By Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA | Published July 22nd, 2019 Question:
What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms.
Answer:
There is no question that these adjustments would be considered ... July 17th, 2019 Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back PainBy Wyn Staheli, Director of Research | Published July 17th, 2019 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 August 14th to officially comment. July 12th, 2019 5 Ways to Minimize HIPAA LiabilitiesBy BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019 Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ... July 8th, 2019 Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?By Wyn Staheli, Director of Research | Published July 8th, 2019 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 that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ... July 8th, 2019 Will the New Low Level Laser Therapy Code Solve Your Billing Issues?By Wyn Staheli, Director of Research | Published July 8th, 2019 Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:
Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ... July 1st, 2019 Rules for Rendering Unproven, Investigational or Experimental ProceduresBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published July 1st, 2019 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 make sure you’re up to speed with this important information. Most providers are surprised to see commonly used devices or techniques listed ... June 25th, 2019 Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?By Wyn Staheli, Director of Research | Published June 25th, 2019 Question:
Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident?
Answer:
There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ... May 27th, 2019 Your New Patient Exam Code Could Determine How Many Visits You GetBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 27th, 2019 - Last Review/Update June 6th, 2019 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 management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ... May 13th, 2019 Electrical Stimulation and Electromagnetic Therapy DevicesBy Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019 Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint. April 29th, 2019 Q/A: I’m Being Audited? Is There a Documentation Template I can use?By Wyn Staheli, Director of Research | Published April 29th, 2019 Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?
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 ... April 22nd, 2019 Auditing Chiropractic ServicesBy By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019 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 seem to struggle to create records that properly support the care provided to the patient throughout the entire episode. April 1st, 2019 Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?By Wyn Staheli, Director of Research | Published April 1st, 2019 I submitted a claim to the VA and it’s being denied. Why?
There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ... April 1st, 2019 Corrections and UpdatesBy Wyn Staheli, Director of Research | Published April 1st, 2019 - Last Review/Update April 2nd, 2019 One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics.
Published Articles
We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ... February 25th, 2019 Medicare Supplemental Policies (MediGap) and Extremity AdjustmentsBy Wyn Staheli, Director of Research | Published February 25th, 2019 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 Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ... February 22nd, 2019 Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?By Wyn Staheli, Director of Research | Published February 22nd, 2019 - Last Review/Update March 5th, 2019 It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them? February 1st, 2019 Physical Therapy Caps Q/ABy Wyn Staheli, Director of Research | Published February 1st, 2019 - Last Review/Update February 4th, 2019 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 only? But still get compensated enough? We have been running into some issues as of late ... January 14th, 2019 AMA Issues new CMT InformationBy Wyn Staheli, Director of Research | Published January 14th, 2019 As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ... January 3rd, 2019 Dry NeedlingBy Wyn Staheli, Director of Research | Published January 3rd, 2019 The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ... January 3rd, 2019 2019 Coding Changes for ChiropracticBy Wyn Staheli, Director of Research | Published January 3rd, 2019 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 code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ... December 20th, 2018 Flexion-Distraction Billing ClarificationBy Wyn Staheli, Director of Research | Published December 20th, 2018 Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ... November 28th, 2018 No Good Deed Goes UnpunishedBy Dr. Ray Foxworth, MCS-P, President of ChiroHealthUSA | Published November 28th, 2018 - Last Review/Update January 21st, 2019 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-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood. November 26th, 2018 CMT Fees in 2019By Wyn Staheli, Director of Research | Published November 26th, 2018 - Last Review/Update January 30th, 2019 Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are. October 22nd, 2018 Q/A: Does My LMT need an NPI? How do I Bill Her Services?By Wyn Staheli, Director of Research | Published October 22nd, 2018 - Last Review/Update December 19th, 2018 Question:
I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, ... October 17th, 2018 Wolters Kluwer Drug PricingBy Find-A-Code | Published October 17th, 2018 Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average... October 16th, 2018 Q/A: What Codes do I use for CLIA-Waived Tests?By Wyn Staheli, Director of Research | Published October 16th, 2018 Question:
I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ... September 24th, 2018 2019 Code Changes are Just Around the Corner - Are You Ready?By Wyn Staheli, Director of Research | Published September 24th, 2018 - Last Review/Update January 28th, 2019 The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ... August 16th, 2018 Importance of Depression ScreeningsBy Wyn Staheli, Director of Research | Published August 16th, 2018 Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ... August 16th, 2018 Q/A: Can I Bill Mechanical Massage?By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019 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 under 97124, but wondered if you have suggested a go-around code. July 25th, 2018 Q/A: Can I Bill Spinal Decompression Table to Insurance?By Wyn Staheli, Director of Research | Published July 25th, 2018 - Last Review/Update January 28th, 2019 Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended? July 12th, 2018 Q/A: Can You Swap Out 97140 with 97530?By Wyn Staheli, Director of Research | Published July 12th, 2018 - Last Review/Update January 28th, 2019 Codes 97140 and 97530 are not interchangeable. See why. June 20th, 2018 Q/A: Should I Bill Massage as 97124 or 97140?By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019 Question
The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ... June 18th, 2018 Q/A: Can a PT Assistant Perform Physical Therapy Modalities?By Wyn Staheli, Director of Research | Published June 18th, 2018 - Last Review/Update January 30th, 2019 Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more. April 30th, 2018 Q/A: Should I be Using Modifier 96 on PT Claims?By Wyn Staheli, Director of Research | Published April 30th, 2018 - Last Review/Update January 30th, 2019 As chiropractors we feel the new modifier 97 is more appropriate than 96 for our PT codes such as stim and traction. Yet Carefirst is asking for 96 only. Should we use this code on all the PT codes and for all the other insurance companies? April 12th, 2018 Billing Nutrition Counseling in a Chiropractic SettingBy Wyn Staheli, Director of Research | Published April 12th, 2018 Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ... March 13th, 2018 When is 97112 Neuromuscular Re-education Billable?By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019 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 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received. February 1st, 2018 Strapping and Kinesio Taping Coding DifferencesBy Wyn Staheli, Director of Research | Published February 1st, 2018 There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally.
Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue.
Coding: ... February 1st, 2018 Traumatic Subluxation Coding ControversyBy Wyn Staheli, Director of Research | Published February 1st, 2018 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 use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ... January 15th, 2018 Medicare Requiring Specific Modifiers on Therapy ServicesBy Wyn Staheli, Director of Research | Published January 15th, 2018 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 begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ... January 15th, 2018 Billing with a GP ModifierBy Wyn Staheli, Director of Research | Published January 15th, 2018 - Last Review/Update January 30th, 2019 Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter? January 9th, 2018 Should ROM Testing be Reported with Evaluation and Management Services?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018 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 EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to. December 12th, 2017 Documenting the Location and Correct CodingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017 The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ... November 6th, 2017 New Payment Rulings Could Affect YouBy Wyn Staheli, Director of Research | Published November 6th, 2017 Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ... October 31st, 2017 Correct Coding for Group TherapyBy David Klein CPC, CPMA, CHC | Published October 31st, 2017 - Last Review/Update February 5th, 2019 Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically regarding the appropriate use of one-on-one codes as opposed to group therapy code CPT 97150 - Therapeutic procedure(s), group (2 or more individuals). This advisory provides guidance on how to properly use one-on-one and group therapy codes, both independently and together. October 20th, 2017 What is the Best Code to use for PNF Stretching of the Hamstrings and Glutes?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 20th, 2017 - Last Review/Update February 8th, 2019 What is the best code to use for PNF stretching of the hamstrings and gluts? The doctor is currently using 97112. October 20th, 2017 A P.A.R.T. TemplateBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 20th, 2017 - Last Review/Update February 5th, 2019 Here at ChiroCode we are often asked for examples of perfect forms to use in the office. As such we have developed some.
October 13th, 2017 Can Chiropractors Opt-out of Medicare?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 13th, 2017 - Last Review/Update February 5th, 2019 Chiropractors cannot opt-opt of Medicare. Does that only refer to chiropractors that see Medicare patients? Do all Florida chiropractors have to complete Medicare enrollment/credentialing? Bottom line- do ALL chiropractors, no matter where or who, have to complete Medicare enrollment since they cannot Opt-out? October 5th, 2017 Q/A: Do we Need to Charge for Non-covered Services Performed Under a Maintenance Visit if we Use the S8990 Code When Billing Medicare?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 5th, 2017 - Last Review/Update February 5th, 2019 Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare? October 5th, 2017 Brace Yourself for New ICD-10 and CPT Codes for 2018!By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 5th, 2017 - Last Review/Update February 5th, 2019 What is new for Chiropractors for 2018? See for yourself the new ICD-10 and CPT Codes. September 25th, 2017 Last Chance to Start Reporting MIPSBy ChiroCode | Published September 25th, 2017 - Last Review/Update February 5th, 2019 MIPS is a program that allows Medicare to collect data from providers about high quality low cost care that uses technology effectively. There are four categories and providers need to learn about the available measures so that they can pick the ones that make them look the best. September 1st, 2017 Quick Tip from ChiroCode -- DocumentationBy ChiroCode | Published September 1st, 2017 - Last Review/Update January 31st, 2019 Documentation Solutions, a quick tip video by Dr Gwilliam. August 17th, 2017 Quick Tip from the HelpDesk -- Code 97140By ChiroCode | Published August 17th, 2017 - Last Review/Update January 31st, 2019 Watch this short video, "Secrets of 97140 Manual Therapy," to learn all that you need to know about the proper support for 97140.
ChiroCode_DeskBook_Tips_97140 from Innoventrum on Vimeo.
... August 16th, 2017 Chiropractic's Unique Role in the Opioid EpidemicBy Dr. Ray Foxworth, Certified Medical Compliance Specialist, President of ChiroHealthUSA, Chiropractor | Published August 16th, 2017 - Last Review/Update February 5th, 2019 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 the early 1980s." Across America, people are talking about chiropractic as a safer alternative to opioid medication for pain relief, and yet, I don't think the magnitude of this opportunity has been realized by most doctors of chiropractic in this country. August 8th, 2017 Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019 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 group of patients? If so, how do I document and bill for this? June 15th, 2017 Negotiating Free Rent – For Medical Professional TenantsBy Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 15th, 2017 Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ... June 13th, 2017 Modifier GY for ChiropracticBy ChiroCode | Published June 13th, 2017 - Last Review/Update January 31st, 2019 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 to BCBS or 99202 billed to Medicare. Is the GY modifier for all insurance companies or just Medicare? May 22nd, 2017 Maintenance Visit DocumentationBy Dr Evan Gwilliam | Published May 22nd, 2017 - Last Review/Update January 31st, 2019 What is required for documenting a maintenance visit for a Medicare beneficiary?
Watch this video by Dr. Evan Gwilliam for his thoughts.
ChiroCodeQ&A_maintenance visit from Innoventrum on Vimeo.
ChiroCode Q&A "Maintenance Visit Documentation" With Dr. Evan Gwilliam. https://vimeo.com/208521720
... April 28th, 2017 Can I be Forbidden from Billing 99204 or 99214?By ChiroCode | Published April 28th, 2017 - Last Review/Update January 31st, 2019 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 this true? Do I have any recourse? March 29th, 2017 National Association of Chiropractic Attorneys (NACA) DirectoryBy | Published March 29th, 2017 National Association of Chiropractic Attorneys (NACA) Directory
Listed by state March 29th, 2017 Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBookBy Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published March 29th, 2017
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 amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ... March 24th, 2017 Are There any Alternatives for Code 97112 Neuromuscular Re-education?By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019 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 insurance benefits. February 23rd, 2017 Physician Compensation Fraud AlertBy Wyn Staheli, Director of Research | Published February 23rd, 2017 In June 2015, the Office of Inspector General (OIG) issued a Fraud Alert focused on physicians and compensation arrangements. Providers need to ensure that these arrangements do not violate the Anti-Kickback Statute. Healthcare providers found to have committed fraud are subject to possible criminal, civil and administrative sanctions.
In this alert ... February 6th, 2017 Quality Reporting is not Just for CMSBy Wyn Staheli, Director of Research | Published February 6th, 2017 If you thought that quality reporting is just for CMS, you are wrong. Other payers recognize the need to establish quality metrics. January 23rd, 2017 HIPAA Exempt Offices (Paper)By Wyn Staheli, Director of Research | Published January 23rd, 2017 It is a common misconception that every doctor’s office is (or must become) a HIPAA covered entity; however, the list of those who still qualify for exemption from HIPAA is rapidly shrinking. There are exceptions to the HIPAA requirements; if a practice sends or receives no transactions electronically, it is ... January 13th, 2017 Whiplash DamagesBy ChiroCode | Published January 13th, 2017 - Last Review/Update January 31st, 2019 Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it. October 25th, 2016 Another OIG Report on ChiropracticBy ChiroCode | Published October 25th, 2016 - Last Review/Update March 5th, 2019 On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). Read hear to see the results. August 3rd, 2016 ICD-10 Changes for 2017By Wyn Staheli, Director of Research | Published August 3rd, 2016 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 October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ... July 5th, 2016 Q&A: We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it?By ChiroCode | Published July 5th, 2016 - Last Review/Update March 4th, 2019 Q&A:
We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it? June 23rd, 2016 Commercial Lease Assignments for Chiropractic TenantsBy Jeff Grandfield and Dale Willerton | Published June 23rd, 2016 When The Lease Coach speaks at chiropractic conventions (such as Parker Seminars in Las Vegas), we are magnets for commercial leasing-related questions. Among the most common are concerns relating to assigning or transferring a Lease Agreement. As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, ... June 23rd, 2016 What Are Unproven, Investigational or Experimental Procedures?By Brandy Brimhall CPC CMCO CPCO CCCPC CPMA | Published June 23rd, 2016 Many specialties, including chiropractors, perform services that may be deemed "experimental, investigational and unproven." Individual payer coverage determinations, as well as state boards, generally offer specific information defining this type of procedure and any other notice or guideline that providers must be aware of and adhere to.The terms "unproven, experimental ... June 15th, 2016 Mastering Medicare: When Opting Out is not an OptionBy Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published June 15th, 2016 - Last Review/Update March 5th, 2019 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 be a provider or a patient is confusing, understanding what is covered is confusing and just about the time you think you have it figured out, you receive a notice that suggests you don’t.
The hassles of Medicare certainly validate any sane person questioning whether they should see a Medicare patient, but with the rising number of Medicare patients in the US do you really want to limit your patient base? June 9th, 2016 Understanding and Using Taxonomy Codes to Maximize ReimbursementBy | Published June 9th, 2016 Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ... May 26th, 2016 Groupon: Is it worth the risk?By Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published May 26th, 2016 - Last Review/Update March 5th, 2019 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 free treatments, or provide gifts or free meals for potential patients. Any one of these things can be considered an “inducement.” Practices that improperly induce patients to seek care or services, for example, by providing coupons for care or supplies, may find that they are in violation of the law if they aren’t careful.
So what will that mean to you and your practice? It isn’t pretty. May 19th, 2016 Your Reasons to Delay Compliance Implementation are GONE!By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published May 19th, 2016 ChiroCode has proudly served chiropractic for more than 30 years and continues to work to bring the most necessary, affordable, and user friendly products and services to practices. Increased regulation has hindered practices by creating uncertainty around the nature of guidelines and the expensive penalties that arise from non-compliance with ... May 13th, 2016 Using the Right DiagnosisBy Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC | Published May 13th, 2016 - Last Review/Update August 16th, 2017 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 affects patient care, treatment or management should be documented and ultimately coded. However, the documentation still needs to support that ... May 3rd, 2016 Using the SBIRTBy Wyn Staheli, Director of Research | Published May 3rd, 2016 Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an effective tool for healthcare providers to identify, reduce, and prevent problematic substance use disorders. Healthcare practices can help their patients and improve their integrated care standards with the proper use of the SBIRT. May 3rd, 2016 Provider/Patient Dynamic Changes as Result of High Deductible PlansBy Wyn Staheli, Director of Research | Published May 3rd, 2016 High-deductible plans are changing the way patients utilize medical services, therefore, providers must also adapt by adjusting both their communication and billing practices to keep pace with these changes. April 30th, 2016 Phase 2 of OCR HIPAA Audits BeginsBy Wyn Staheli, Director of Research | Published April 30th, 2016 Phase 2 of HIPAA audits have begun. What do you need to know? April 13th, 2016 Lack of Business Associate Agreement (BAA) Costs Non-Profit 1.55 MillionBy Wyn Staheli, Director of Research | Published April 13th, 2016 Failure to have a properly executed Business Associate Agreements (BAA) costs one organization $1.55 Million. In today's highly technological environment, it is too easy to skip the necessary precautions and easy for electronic devices to get lost or stolen. Are you prepared? April 6th, 2016 HIPAA Violations - The Process Is The AnswerBy Instacode Institute | Published April 6th, 2016 It's not just the names and addresses that matter -- It's the compliance. If you can demonstrate that you are hleping yourself to maintain HIPAA compliance by careful documentation and proper procedures, you can go a long way toward avoiding being fined by the HIPAA squads.
Complete & Easy HIPAA Compliance is a clear, simple “Just help me do what I have to do!” workbook that contains all the things the designated security officer must do to instantiate a robust HIPAA compliance program. It comes complete with over 45 forms and letters which can be used to state the office policies, spell out procedures, and ensure that each patient will be protected in their rights under HIPAA policy. It also can help demonstrate that a compliance program is in progress. April 5th, 2016 Voluntary Disclosure - Look Before You LeapBy ChiroCode | Published April 5th, 2016 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 disclosing information to the government. March 16th, 2016 Protected Health Information De-Identification StandardsBy Instacode Institute | Published March 16th, 2016 - Last Review/Update January 27th, 2017 This article contains detailed information on the OCR guidance regarding the de-identification of Protected Health Information (PHI). Avoid HIPAA violations and learn specifically what de-identification is. February 24th, 2016 Employee Exclusions Screenings Must be High PriorityBy Wyn Staheli | Published February 24th, 2016 Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. This article has important information for organization to ensure compliance. January 6th, 2016 6 ways to stop filing duplicate Medicare claims - Duplicates could expose your practice to fraud investigationBy | Published January 6th, 2016 Whenever a Medicare Administrative Contractor (MAC) releases a list of the top reasons for claims denials, the list almost never fails to include duplicate claims. When the MAC perceives the claim to be a duplicate, based typically on a match of the patient identifying information, furnishing... October 5th, 2015 Reporting Laterality Still Requires ModifiersBy Wyn Staheli, Director of Research | Published October 5th, 2015 One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).
Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology ... August 19th, 2015 Chiropractic Listed as Focal Point in 2015 OIG Work PlanBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published August 19th, 2015 - Last Review/Update January 30th, 2017 With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses the ... August 10th, 2015 Manipulation Under Anesthesia in the OfficeBy | Published August 10th, 2015 - Last Review/Update January 27th, 2017 When manipulation under anesthesia is done in the office instead of a facility, code selection is different. August 10th, 2015 Hardship DiscountsBy ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017 What are they and how can I safely create one based on the patient's poverty level? August 10th, 2015 Chiropractic Tenants – Choosing the Location Where Your Practice will ThriveBy By Jeff Grandfield & Dale Willerton – The Lease Coach | Published August 10th, 2015 As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies (Wiley, 2013) and when we recently spoke at Parker Seminars in Las Vegas, finding the right location or property for your practice is one of the most important decisions you can make. It’s not always easy, ... August 10th, 2015 Audit Fighting TacticsBy Tom Necela, DC, CPC, CPMA, CCP-P | Published August 10th, 2015 - Last Review/Update January 27th, 2017 Four Tactics or tips to help you fight back when you are audited or have your claims reviewed. They are effective and easy to use. August 10th, 2015 Alphabet Soup for Waste and Fraud InspectorsBy ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017 The following are some of the acronyms you would need to know when communicating with auditors:
National Correct Coding Initiative (NCCI) Edits: Use of codes that should not occur on the same day, effectively treating the same area twice.
Medically Unlikely Edits (MUE): Exceeding the anticipated units of service (time spent) for a given HCPCS or CPT code.
Office of the ... August 10th, 2015 Can Chiropractors Bill 99211?By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse’s code, is not really made for the physician to use. In fact, the AMA, CPT ... August 10th, 2015 Adjunctive (Add-On) CodesBy ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017 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 few examples of coding that are often overlooked.
97014 & 97032 Electrical Stimulation Supplies
According to the Relative Value Update Committee (RUC), ... August 3rd, 2015 Chiropractors - Negotiate a Mid-term Rent Reduction for Your Commercial LeaseBy Jeff Grandfield and Dale Willerton - The Lease Coach | Published August 3rd, 2015 When The Lease Coach spoke at Parker Seminars in Las Vegas, we met a number of struggling chiropractors leasing commercial space. These chiropractic tenants desperately need a rent reduction ... right now. June 29th, 2015 HIPAA Standards for ClaimsBy Find-A-Code | Published June 29th, 2015 (Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014) The standards adopted under HIPAA include both a transaction standard and an implementation guide. The following are the claims transactions and the implementation ... June 10th, 2015 Buying vs. Leasing Commercial Practice Space: Pros and Cons for Chiropractic TenantsBy By: Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 10th, 2015 As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, the most common reason tenants lease space instead of buying a location is because 95 percent of all commercial and office space is for lease and not for sale.
If you are in an enviable position ... April 24th, 2015 Have you been excluded from Medicare?By Dr. Chris Andersn | Published April 24th, 2015 - Last Review/Update June 9th, 2016 Compliance is an issue that you should look at as an expedition rather than an endpoint. Board complaints can be a terrifying ordeal, especially if you don’t keep up on compliance in your clinic. Board complaints are something that you have to expect to happen but you can turn that ... February 26th, 2015 Chiropractic Billing 101: A Basic GuideBy | Published February 26th, 2015 - Last Review/Update January 27th, 2017 Director of Communications, ChiroCode
In my 20 years of professional bull riding I have had many highs and lows. There were times when the rankest of bulls couldn’t throw me and times when I couldn’t ride a rocking chair. When in a slump, what always worked for me, and for the ... February 23rd, 2015 Q & A: Why is Medicare Denying Claims?By | Published February 23rd, 2015 - Last Review/Update March 9th, 2016 Q: We have recently enrolled with Medicare and treat only a few patients. However, those claims are being denied. Can you help me to understand why this might be happening?
A: First, I would recommend you carefully review your Medicare Remittance Advice as that will identify the reason Medicare is denying your ... February 13th, 2015 Chiropractic Services - Aetna Clinical Policy BulletinBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 13th, 2015 - Last Review/Update March 1st, 2016 AETNA
Clinical Policy Bulletin: Chiropractic Services
Number: 0107
http://www.aetna.com/cpb/medical/data/100_199/0107.html
Policy
Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
The member has a neuromusculoskeletal disorder; and
The medical necessity for treatment is clearly documented; and
Improvement is ... January 26th, 2015 Documentation ResourcesBy ChiroCode | Published January 26th, 2015 - Last Review/Update January 30th, 2017 Documentation is essential to establishing medical necessity and the level of services provided to the patient. Treatment plans and outcome assessments are crucial elements to thorough documentation.
This page is only a general listing of documentation resources for chiropractic. More thorough and detailed explanations are found in Section D-Documentation in the ... January 23rd, 2015 Chiropractic Listed as Focal Point in 2015 OIG Work PlanBy | Published January 23rd, 2015 - Last Review/Update January 30th, 2017 With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses ... December 30th, 2014 Understanding TOS Discounts and DMPOsBy | Published December 30th, 2014 - Last Review/Update March 9th, 2016 Time-of-Service (TOS) discounts are a common occurrence in chiropractic. What is often assumed is that if insurance isn't involved, there are no rules that apply.
Unfortunately, this is a myth that can become costly to practices and damage provider/patient relationships. So read on to learn the facts about TOS discounting and ... December 15th, 2014 OIG Reports Success in Efforts to Prevent Fraud, Waste, and AbuseBy | Published December 15th, 2014 - Last Review/Update January 30th, 2017 The HHS OIG Work Plan for the 2015 Fiscal Year has recently been released. In this publication, the OIG addresses the accomplishments made from the previous year's Plan as well as the objectives that will be of interest for the coming new year. Accomplishments for the 2014 Fiscal Year are ... December 3rd, 2014 Coding for Laser TherapyBy | Published December 3rd, 2014 - Last Review/Update January 30th, 2017 The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnosis code.
Coverage for laser, as with any other service, is strictly dependent upon the ... December 1st, 2014 Q & A: Establishing a Multi-Disciplinary Practice and Being LegalBy | Published December 1st, 2014 - Last Review/Update January 30th, 2017 Q: How do you add another provider type such as a Nurse Practitioner to your practice to provide additional services to patients and legally bill for those services under their license?
A: Multi-disciplinary practices are under scrutiny at the moment by ZPIC, CMS and State Boards. For your reference, just below, there ... November 25th, 2014 Have you checked your QRUR to find out if you qualify for a CMS bonus (or penalty)?By | Published November 25th, 2014 - Last Review/Update January 30th, 2017 What? You've never heard of a QRUR?
You have probably heard about Meaningful Use (MU) and penalties that kick in for those who did not attest. And the Physician Quality Reporting System (PQRS) with penalties for those who did not successfully report on at least one patient. The new one ... November 21st, 2014 Coding for Laser TherapyBy | Published November 21st, 2014 - Last Review/Update January 30th, 2017 The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ... November 21st, 2014 Understanding TOS Discounts and DMPOsBy | Published November 21st, 2014 - Last Review/Update January 30th, 2017 Time-of-Service (TOS) discounts are a common occurrence in chiropractic. What is often assumed is that if insurance isn't involved, there are no rules that apply.
Unfortunately, this is a myth that can become costly to practices and damage provider/patient relationships. So read on to learn the facts about TOS discounting and ... November 21st, 2014 Establishing a Multi-Disciplinary Practice and Being LegalBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017 Q: How do you add another provider type such as a Nurse Practitioner to your practice to provide additional services to patients and legally bill for those services under their license?
A: Multi-disciplinary practices are under scrutiny at the moment by ZPIC, CMS and State Boards. For your reference, just below, there ... November 19th, 2014 Understanding RACBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 19th, 2014 - Last Review/Update January 30th, 2017 Recovery Audit Contractors, also known as RAC, is a program that seeks to identify and correct improper payments for services provided to Medicare Parts A & B beneficiaries. This includes both recoupment of overpayments and corrected distribution of underpayments made by CMS.  RAC began in 2005 as a three-year demonstration project consisting ... November 17th, 2014 Conducting a Gap Analysis for Your Documentation & Billing SystemsBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 17th, 2014 - Last Review/Update January 30th, 2017 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 objective of a Gap Analysis is to ensure that the practice is in full compliance with applicable legal and ethical requirements. This ... November 7th, 2014 Q & A: 97022 and Dry HydromassageBy | Published November 7th, 2014 - Last Review/Update January 30th, 2017 Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do not select a ... October 24th, 2014 Q & A: Is it a HIPAA Violation to Email Patients?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2014 - Last Review/Update January 30th, 2017 Straight from the Office of Civil Rights:
Q: Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?
A: Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply ... October 22nd, 2014 Q & A: 97022 and Dry HydromassageBy | Published October 22nd, 2014 - Last Review/Update January 27th, 2017 Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do ... October 16th, 2014 Is Compliance a Dirty Word?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 16th, 2014 - Last Review/Update January 23rd, 2017 In October of 2000 in the Federal Register the Office of the Inspector General (who investigates fraud against the federal government on behalf of the Department of Health and Human Services) offered general guidelines for health care facilities to set up a “Compliance Program”. This advice has long been pushed ... October 16th, 2014 Chiropractic is Listed as a Priority in the 2014 OIG Work Plan...Find Out WhyBy Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published October 16th, 2014 - Last Review/Update January 30th, 2017 Each year the Office of Inspector General (OIG) issues an updated work plan which outlines the objectives and enforcement priorities for each new year. For Medical providers, including Chiropractic, this information is necessary to review and be familiar with so we may evaluate our own practice systems to ensure compliance ... October 3rd, 2014 Good Attorneys and Bad AttorneysBy | Published October 3rd, 2014 - Last Review/Update January 27th, 2017 A “good” lawyer could be a “bad” lawyer when it come to your unique problem(s). Never ask or expect any professional person (doctor or lawyer) to perform beyond their scope of practice or ability. A college law degree and passing the state bar, is only a license which permits them ... September 26th, 2014 Patient Electronic Access Tipsheet - Measure ComplianceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 26th, 2014 - Last Review/Update January 30th, 2017 MEASURE COMPLIANCE - Meeting the Patient Electronic Access Objective
Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health information in a timely manner. Providers participating in ... September 15th, 2014 Can Chiropractors Bill 99211?By | Published September 15th, 2014 - Last Review/Update January 30th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse's code, is not really made for the physician to use. In fact, the AMA, ... September 11th, 2014 According to HIPAA, who are my Business Associates?By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published September 11th, 2014 - Last Review/Update January 30th, 2017 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 Associates the Department of Health & Human Services has provided some resources.
But first … what is PHI or individually identifiable health information? ... July 31st, 2014 Fill In Doctor: Locum TenensBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017 It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ... July 31st, 2014 Can Chiropractors Bill 99211?By | Published July 31st, 2014 - Last Review/Update January 25th, 2017 This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged. The 99211 code, also known as the nurse's code, is not really made for the physician to use. ... July 31st, 2014 GP Modifier for Physio Therapy ServicesBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017 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 typically use the following Physical Medicine codes from the CPT book: 97010 thru 97799 (except for 97597-97610 for active wound care management). The current ... July 24th, 2014 Are Medicare fees going up? Or down?By | Published July 24th, 2014 - Last Review/Update January 29th, 2016 Are Medicare fees going up? Or down? Results for the following:
Sequestration
Chiropractic Demonstration Project
Electronic Health Record/Meaningful Use
Physician Quality Reporting System - PQRS
Value-Based Modifier July 24th, 2014 Are Medicare fees going up? Or down?By | Published July 24th, 2014 - Last Review/Update January 25th, 2017 PAMA (up 0.5%)
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that went into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after ... February 19th, 2014 Are Text Messages HIPAA Compliant?By | Published February 19th, 2014 - Last Review/Update January 27th, 2017 As more and more people are using mobile and wireless devices, a new buzzword has emerged: mHealth. According to a National Institute of Health consensus group, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services and health research." Historically, the biggest gaps and HIPAA violations ... September 30th, 2013 Are You Compliant with the New HIPAA Regulations?By | Published September 30th, 2013 - Last Review/Update January 27th, 2017 September 23rd, 2013 was the deadline for HIPAA Omnibus Final Rule compliance. It seems to have just snuck up on everybody. ChiroCode has spoken with some clincis who say that they don't need to worry about it because ”they are just a small practice.” Please, do not wait any longer to ... September 24th, 2013 Federal Health Care Fraud Summary 2012By | Published September 24th, 2013 - Last Review/Update January 27th, 2017 Be aware of the possible monetary results and enforcement actions imposed for fraud. This is the annual report of the Department of Justice Health Care Fraud and Abuse Control Program for FY 2012 September 11th, 2013 ICD-10 Coding Possibilities for Chiropractic PhysiciansBy Evan M Wsilliam, DC, CPC, CCPC, NCICS, CCCPC, CPC-I, MCS-P, CPMA | Published September 11th, 2013 - Last Review/Update January 27th, 2017 Right now, it’s hard to say which ICD-10 codes third-party payers will select as medically necessary, but we can make an educated guess based on information from a few sources. More detail is expected from Medicare before the end of 2013. For doctors of chiropractic (DCs), the natural place to start is with the relatively short list of frequently used ICD-9-CM codes for submitting claims. We’ll investigate a handful of diagnosis codes that Medicare recognizes as medically necessary and explore ICD-10-CM code possibilities. July 25th, 2013 Medicare Considering Paying DCs for E/M ServicesBy | Published July 25th, 2013 - Last Review/Update January 27th, 2017 A notice in the July 19, 2013 Federal Register, has a VERY important clause for all Doctors of Chiropractic! The Centers for Medicare and Medicaid Services (CMS) has asked for comment on whether or not Doctors of Chiropractic should be paid for Evaluation and Management (E/M) services. Keep in mind ... December 31st, 2001 Commonly Asked Chiropractic Coding QuestionsBy ChiroCode | Published December 31st, 2001 - Last Review/Update August 19th, 2015 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 Findings
8. Laser therapy
9. Spinal Decompression
10. Diagnosis Coding – 4th and 5th digit
11. Re-Reading X-rays
12. Outcomes Assessment Questionnaires
13. Accounts Receivable
14. 15-Minute Units
15. E/M and CMT December 31st, 1969 National Association of Insurance Commissioners (NAIC) DirectoryBy | Published December 31st, 1969 - Last Review/Update August 10th, 2015 National Association of Insurance Commissioners (NAIC) Directory
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