For professional services/procedures billed to third party payers, which are reported on the 1500 Claim Form, there are two recognized procedural coding sets that may be used for HIPAA transactions: the American Medical Associations’ Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS).
For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. Because of the dependability and education ChiroCode has earned much renown. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more.
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June 3rd, 2020
Watch for Payer Telehealth Coverage Changes
By 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.
More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About
By 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.
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
By 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 ...
By 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.
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...
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 ...
Your New Patient Exam Code Could Determine How Many Visits You Get
By 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 ...
Electrical Stimulation and Electromagnetic Therapy Devices
By 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.
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 ...
By 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.
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 ...
By 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 ...
By 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 ...
By 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 ...
By 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 ...
By 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 ...
By 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 ...
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 ...
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 ...
By 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 ...
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.
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 ...
Billing Nutrition Counseling in a Chiropractic Setting
By 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 ...
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.
By 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: ...
By 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 ...
Medicare Requiring Specific Modifiers on Therapy Services
By 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 ...
By 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?
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.
By 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 ...
By 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.
By 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.
...
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?
By 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?
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?
Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook
By 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 ...
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.
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 ...
By 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.
By 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 ...
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 ...
By 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), ...
By 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 ...
By | 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 ...
By | 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 ...
By | 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 ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | 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 ...
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, ...
By 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” ...
By 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
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. ...
By 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 ...
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
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 ...
By | 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 ...
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December 18th, 2018
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.
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA June 19, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Are you getting denials from payers for things that they say are bundled into chiropractic manipulative treatment (CMT) codes? ...
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.
Which is the Most Profitable E/M Code for PI: 99203 or 99204?
There is a lot of myth surrounding the use of the E/M codes. Dr. Grant will discuss how to best use these codes in a PI case to avoid the potential for a fraud claim by an insurer or a malpractice action by your patient.
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