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To read Noridian's article CLICK HERE.

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General Coverage and Subluxation

Noridian - Chiropractic General Coverage and Subluxation

Noridian: Chiropractic Resources

Noridian JE Part B Chiropractic Resources

Chiropractic Services Fact Sheet

This Fact Sheet is for informational purposes only and is not intended to guarantee payment for services...

Chiropractic Articles

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Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?

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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?

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Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?

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Question Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3. Also, it shows the ...

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Your New Patient Exam Code Could Determine How Many Visits You Get

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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 ...

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Electrical Stimulation and Electromagnetic Therapy Devices

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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.

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Q/A: I’m Being Audited? Is There a Documentation Template I can use?

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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 ...

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Auditing Chiropractic Services

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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.

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Q/A: What’s Wrong with the Diagnoses on my Claim?

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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.

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Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?

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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 ...

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Corrections and Updates

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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 ...

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Medicare Supplemental Policies (MediGap) and Extremity Adjustments

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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 ...

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Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?

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

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Physical Therapy Caps Q/A

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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 ...

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AMA Issues new CMT Information

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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 ...

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Dry Needling

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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 ...

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2019 Coding Changes for Chiropractic

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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 ...

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Flexion-Distraction Billing Clarification

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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 ...

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Billing Exercise Equipment

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While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...

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No Good Deed Goes Unpunished

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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.

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CMT Fees in 2019

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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.

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Muscle Testing and Range of Motion Information

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Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.

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Q/A: Does My LMT need an NPI? How do I Bill Her Services?

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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, ...

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Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder

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The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...

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Wolters Kluwer Drug Pricing

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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...

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Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?

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Question: We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...

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Q/A: What Codes do I use for CLIA-Waived Tests?

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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 ...

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2019 Code Changes are Just Around the Corner - Are You Ready?

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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 ...

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Importance of Depression Screenings

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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 ...

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Q/A: Can I Bill Mechanical Massage?

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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.

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Q/A: How Do I Release a Patient from PI When They Still Have Problems?

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Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs? We have discussed this with several different experts. The consensus is....

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Q/A: Can I Bill Spinal Decompression Table to Insurance?

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Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?

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Q/A: Can You Swap Out 97140 with 97530?

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Codes 97140 and 97530 are not interchangeable. See why.

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Q/A: Should I Bill Massage as 97124 or 97140?

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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 ...

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Q/A: Can a PT Assistant Perform Physical Therapy Modalities?

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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.

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CEU’s Now Available

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 CEU’s are now available for the following Webinars:        Practice Risk Areas, Presented by Brandy Brimhall   (1 CEU)        Secrets of Chiropractic Documentation, Presented by Compliant Coding Systems.  (4 CEU’s)  CEUs are available in the following states: Alaska Connecticut District of Columbia Idaho   Indiana Iowa Kansas Maine   Maryland Massachusetts Minnesota Montana Nebraska Nevada New Jersey North Carolina North Dakota Ohio Oregon Rhode Island South Carolina South Dakota Tennessee Utah Washington Vermont Virginia Wyoming Puerto Rico Nova Scotia       NOTE:   "Additional states may be ...

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Q/A: Should I be Using Modifier 96 on PT Claims?

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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?

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Billing Nutrition Counseling in a Chiropractic Setting

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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 ...

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When is 97112 Neuromuscular Re-education Billable?

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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.

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OIG Issues Renewed Focus on Chiropractic Services

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The OIG recently released a "Portfolio" regarding chiropractic service which stated (emphasis added): This portfolio presents an overview of program vulnerabilities identified in prior Office of Inspector General (OIG) audits, evaluations, investigations, and legal actions related to chiropractic services in the Medicare program. It consolidates the findings and issues identified in ...

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Strapping and Kinesio Taping Coding Differences

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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: ...

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Traumatic Subluxation Coding Controversy

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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 ...

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Patient Relationship Codes

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Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following: care episode groups patient condition groups patient relationship categories Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...

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Billing with a GP Modifier

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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?

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Should ROM Testing be Reported with Evaluation and Management Services?

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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.

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Chiropractic Tips


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Chiropractic Webinars

Click the webinar title to view a summary and link to the webinar video.

March 5th, 2019: Evaluation and Management Coding

The Evaluation and Management service is an important part of an episode of care. It is the initiation of care and determines the scope and severity of the patient’s condition. Dr. Ron Short will review the levels of Evaluation and Management codes and which are appropriate in the chiropractor’s office. In this webinar you will learn: What constitutes a new patient Which Evaluation and Management codes should not be used When to use the consultation code What changes are coming to Evaluation and Management coding

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E/M and the Organ Systems Part 2 of 2

E/M and the Organ Systems Part 2 of 2

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E-M and the Organ Systems (Part 1)

E-M and the Organ Systems (Part 1)

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Chiropractic Manipulative Treatment and Medicare - Part 2

In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.

Watch the video on ChiroCode.com →

Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1)

The most used codes in chiropractic are 98940, 98941, 98942, and 98943. In this webinar, Dr. Gwilliam will go over the fundamentals of these codes and make sure you are proficient with them. They probably play a bigger part of your practice than any other code, so it is worth it to make sure you are reporting them correctly. By the end of this presentation you will be able to diagnose, document, and code properly for CMT, as well as avoid common mistakes.

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The #1 most overlooked injury in PI, and it is found in over 90% of all cases

Presented by Tom Grant Jr. DC  December 11, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET *How to recognize this injury *The most effective documentation terms to use *The best combination of ICD-10 codes to validate it Register here: https://attendee.gotowebinar.com/register/8562161323381676035 ...

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Documenting Treatment Plan and Goals That Actually WORK - November 20th, 2018

Dr. Friedman will discuss the need to document Treatment Plan and Goals and what we MUST document and what we SHOULD document. He'll also demonstrate how we can do this in the least amount of time and with the least amount of effort.

Watch the video on ChiroCode.com →

Chiropractic Practice For Sale - When, Where, Why & How Much?

Dr. Tom Necela of The Strategic Chiropractor will share tips & tactics to help you with some of the biggest decisions every doc faces towards the end of their career: when to sell, where to find buyers, why sell (and what other options are available) and of course, how much is your chiropractic practice worth. If you are considering a chiropractic practice sale or transition within the next few years, this is a webinar you won't want to miss!

Watch the video on ChiroCode.com →

Joints: Rotator Cuff, Elbow, Wrist, and Hand

In this webinar, Brandon will review the bones and major joints of the upper extremities (arm, forearm, wrist, hand, and digits), as well as their supporting structures and how they are affected by injury, disease, and other conditions.

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The Most Expensive Documentation Mistakes Chiropractors Make

Notes need to give payers the information they need in order to adjudicate your claims. Do your notes include what they need to see? Can you standardize and simplify your note taking process to decrease your administrative burden? In this webinar, Dr. Gwilliam, Certified Coder, Certified Professional Medical Auditor, and Clinical Director for PayDC Chiropractic EHR Software, will show you how to make it easy. He will review examples and boost your confidence that you are doing things correctly.

Watch the video on ChiroCode.com →

Coding and Documenting Physical Therapy Treatment Modalities

Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA May 22nd, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Ever wonder how to get paid for that e-stim or ultrasound? Do payers give you a hard time and ...

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How to Add Acupuncture to a Chiropractic Office

In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to add Acupuncture services to a Chiropractic office. Topics include how to find and employ acupuncturists, CPT/ICD-10 coding, 15 minute increments vs the 8 minute rule, how to bill for office visits on same day as acupuncture and how to create an acupuncture billing and coding policy manual.

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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Chiropractic Resources/Links




For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more. Because of the dependability and education, ChiroCode has earned much renown.

Chiropractic Resources

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