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).
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Chiropractic Procedure Coding Articles
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New Codes for Dry Needling
September 30th, 2019
Published September 30th, 2019|
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019
Published August 13th, 2019|
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
July 8th, 2019
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 ...
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
May 29th, 2019
Published May 29th, 2019 - Last Review/Update June 4th, 2019|
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?
Your New Patient Exam Code Could Determine How Many Visits You Get
May 27th, 2019
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
May 13th, 2019
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?
April 29th, 2019
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 ...
Auditing Chiropractic Services
April 22nd, 2019
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?
April 1st, 2019
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 ...
Corrections and Updates
April 1st, 2019
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 ...
Q/A: Do Digital X-rays Have Their Own Codes?
February 7th, 2019
Published February 7th, 2019 - Last Review/Update February 8th, 2019|
Question Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes? Answer There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
Physical Therapy Caps Q/A
February 1st, 2019
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 ...
AMA Issues new CMT Information
January 14th, 2019
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
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 ...
2019 Coding Changes for Chiropractic
January 3rd, 2019
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 ...
Flexion-Distraction Billing Clarification
December 20th, 2018
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 ...
Billing Exercise Equipment
November 29th, 2018
Published November 29th, 2018|
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 ...
CMT Fees in 2019
November 26th, 2018
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.
Muscle Testing and Range of Motion Information
November 8th, 2018
Published November 8th, 2018|
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Q/A: What Codes do I use for CLIA-Waived Tests?
October 16th, 2018
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?
September 24th, 2018
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 ...
Importance of Depression Screenings
August 16th, 2018
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 ...
Q/A: Can I Bill Mechanical Massage?
August 16th, 2018
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.
Q/A: Can I Bill Spinal Decompression Table to Insurance?
July 25th, 2018
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?
Q/A: Can You Swap Out 97140 with 97530?
July 12th, 2018
Published July 12th, 2018 - Last Review/Update January 28th, 2019|
Codes 97140 and 97530 are not interchangeable. See why.
Q/A: Should I Bill Massage as 97124 or 97140?
June 20th, 2018
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
April 12th, 2018
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?
March 13th, 2018
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.
Strapping and Kinesio Taping Coding Differences
February 1st, 2018
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: ...
Traumatic Subluxation Coding Controversy
February 1st, 2018
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 ...
Q/A: Can I Perform 2 Untimed Codes at the Same Time?
January 31st, 2018
Published January 31st, 2018 - Last Review/Update February 4th, 2019|
Question: Can two untimed codes be performed at the same time? For instance can I perform lumbar traction (97012) at the same time as e-stim (97014)?
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 2018
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 ...
Billing with a GP Modifier
January 15th, 2018
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?
January 9th, 2018
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.
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Chiropractic Procedure Coding Tips
Chiropractic Procedure Coding Webinars
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Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1)
October 16th, 2018
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.
How to Add Acupuncture to a Chiropractic Office
January 29th, 2018
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?
September 6th, 2017
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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