Chiropractic Procedure Coding Articles and Resources

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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Resources

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Sep 15th, 2022

Emergency Department - APC Reimbursement Method

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...

Jul 13th, 2022

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

Jul 12th, 2022

E/M Changes Coming Our Way in 2023!

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Changes are one thing we can count on being consistent; even though this is one we have been anticipating, it is time to prepare, and we will have some work to do. The AMA released the new 2023 E/M Guidelines early to help us prepare for the change effective January ...

Mar 31st, 2022

$636 Million in Overpayments Made by Medicare to Providers for Neurostimulators

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES." So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...

Mar 21st, 2022

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM

by Stephanie Allard, CPC CEMA RHIT

When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...

Nov 11th, 2021

Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...

Oct 28th, 2021

Understanding ASCs and APCs: Indicators and Place of Service

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

Oct 4th, 2021

Watch out for New ICD-10-CM Codes

by Wyn Staheli, Director of Content - innoviHealth

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.

Sep 29th, 2021

Injection Services

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

Aug 4th, 2021

Understanding How Place of Service Codes Work

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...

Jul 29th, 2021

Medicare's ABN Booklet Revised

by Wyn Staheli, Director of Content - innoviHealth

The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.

Jun 3rd, 2021

Understanding Non-face-to-face Prolonged Services (99358-99359) in 2021

by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Due to the extensive changes in office or other outpatient services (99202-99215), there are many questions which still need to be answered, one of which is related to the prolonged services without face-to-face contact. This article explores the question regarding the appropriate use of codes 99358/99359 and how to report it.

May 20th, 2021

Intersegmental Traction — What’s Happening with Roller Tables?

by Wyn Staheli, Director of Content - innoviHealth

Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?

May 4th, 2021

Comparison of Add-On Code Guidelines

by Wyn Staheli, Director of Content - innoviHealth

Add-on codes are codes that are not intended to be reported alone. They are reported with another primary procedure to identify that additional services have been provided in conjunction with that primary procedure. Generally, they include the words “List separately in addition to code.” Interestingly, there are some differences in the instructions/guidelines regarding the use of these codes in the CPT® codebook, the NCCI Policy Manual, and on the CMS website. This article outlines the differences between each of these.

Apr 19th, 2021

Q/A: For E/M, How do I Count Tests Ordered in One Department and Performed in Another?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Question: I am in an ENT office as part of a large clinic with separate practices including audiology, CT, and allergy, all billing under the same TAX ID. Sometimes tests are ordered which are done in other departments that my office does not bill for, would those be considered an outside source? Answer: This is a great question and one that has been asked by many coders and auditors.

Apr 1st, 2021

Evaluation & Management (E/M) Webinar Q/A

by Wyn Staheli, Director of Content - innoviHealth and Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Find answers to some questions asked by attendees of our recent webinar regarding the changes released by the AMA in their March 9, 2021 Errata and Technical Corrections document in relation to Evaluation & Management (E/M).

Mar 18th, 2021

How Reporting E/M Based on Time May Lose Money

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...

Mar 16th, 2021

Critical Evaluation and Management Changes Recently Announced by AMA

by Wyn Staheli, Director of Content - innoviHealth

On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.

Feb 17th, 2021

Why CMS Created G2212 for Prolonged Services Instead of 99417

by Wyn Staheli, Director of Content - innoviHealth

This article discusses WHY CMS decided to create code G2212 to be used with prolonged office Evaluation and Management (E/M) services instead of code 99417 as of January 1, 2021. The proposed Medicare Physician Fee Schedule stated that code 99417 would be used so it is essential to understand why they made this change to avoid potential problems with billing these services.

Feb 3rd, 2021

How To Properly Report Prolonged Services Using 99417 or G2212

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Prolonged Evaluation & Management codes underwent big changes in 2021, including the creation of a new prolonged code (99417), reportable only with codes 99205 or 99215. While Medicare has agreed to accept the AMA's CPT E/M coding changes, they have formulated an opinion contrary to how CPT calculates time specific ...

Oct 12th, 2020

What is the Difference Between the Medicare 1995 and 1997 Documentation Guidelines for E/M Services?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

When Medicare determined that providers could follow EITHER the 1995 OR the 1997 Documentation Guidelines for Evaluation and Management Services to determine which level of E/M service to report, because CMS had not clarified that portions of the 1995 and 1997 guidelines could be used together to determine the level of ...

Aug 10th, 2020

Modifier 50 — Four "Must Know" Tips For Getting Paid

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

Jul 14th, 2020

Are NCCI Edits and Modifiers Just for Medicare?

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

Jun 10th, 2020

MEGA - NCCI Edit Changes - WHO Knew?

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197 Deleted Medically Unlikely ...

May 13th, 2020

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

Mar 31st, 2020

CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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 ...

Mar 24th, 2020

"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...

Mar 21st, 2020

Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

by Aubrie Rowley

The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

Jan 14th, 2020

Billing for Telemedicine in Chiropractic

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Jan 14th, 2020

Q/A: Can Chiropractors Bill 99211?

by Wyn Staheli, Director of Content - innoviHealth

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...

Sep 30th, 2019

New Codes for Dry Needling

by Wyn Staheli, Director of Content - innoviHealth

Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.

Aug 20th, 2019

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

Aug 13th, 2019

How to Properly Report Prolonged Evaluation and Management Services

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement? Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...

Aug 13th, 2019

Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?

by Wyn Staheli, Director of Content - innoviHealth

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.

Jul 8th, 2019

Will the New Low Level Laser Therapy Code Solve Your Billing Issues?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jun 13th, 2019

What Medical Necessity Tools Does Find-A-Code Offer?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...

Jun 6th, 2019

How to Code Ophthalmologic Services Accurately

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code. According to Article A19881 which was published in 2004 and ...

May 29th, 2019

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

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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?

May 27th, 2019

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

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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 ...

Apr 29th, 2019

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

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Apr 23rd, 2019

Let's Talk High Risk E/M Services

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services. Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

Apr 23rd, 2019

What is Medical Necessity and How Does Documentation Support It?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

Apr 22nd, 2019

Auditing Chiropractic Services

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Apr 1st, 2019

Corrections and Updates

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Apr 1st, 2019

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

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Mar 21st, 2019

The Impact of Medical Necessity on High Level E/M Services

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?" The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

Mar 18th, 2019

How to Report Imaging (X-Rays) of the Thumb

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...

Mar 4th, 2019

UnitedHealthcare to Discontinue Coverage of Consultations

by Wyn Staheli, Director of Content - innoviHealth

In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).

Mar 1st, 2019

Understanding NCCI Edits

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

Feb 14th, 2019

Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...

Feb 12th, 2019

Coding Medicare Initial Preventive Physical Exams (IPPE)

by Aubrie Rowley

The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward. Purpose An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...

Feb 7th, 2019

Q/A: Do Digital X-rays Have Their Own Codes?

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Feb 5th, 2019

Clinical Staff vs. Healthcare Professional

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals. Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges. Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...

Feb 1st, 2019

Physical Therapy Caps Q/A

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jan 3rd, 2019

2019 Coding Changes for Chiropractic

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jan 3rd, 2019

Dry Needling

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Dec 20th, 2018

Flexion-Distraction Billing Clarification

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Nov 26th, 2018

CMT Fees in 2019

by Wyn Staheli, Director of Content - innoviHealth

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.

Nov 8th, 2018

Muscle Testing and Range of Motion Information

by Wyn Staheli, Director of Content - innoviHealth

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

Oct 16th, 2018

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

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Sep 24th, 2018

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

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Aug 16th, 2018

Importance of Depression Screenings

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Aug 16th, 2018

Medicare Timed Codes Guidelines

by Wyn Staheli, Director of Content - innoviHealth

Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...

Aug 16th, 2018

Q/A: Can I Bill Mechanical Massage?

by Wyn Staheli, Director of Content - innoviHealth

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.

Aug 16th, 2018

Using Modifiers 96 and 97

by Wyn Staheli, Director of Content - innoviHealth

The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...

Jul 25th, 2018

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

by Wyn Staheli, Director of Content - innoviHealth

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

Jul 12th, 2018

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

by Wyn Staheli, Director of Content - innoviHealth

Codes 97140 and 97530 are not interchangeable. See why.

Jun 20th, 2018

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

by ChiroCode™

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 ...

Apr 12th, 2018

Billing Nutrition Counseling

by Wyn Staheli, Director of Content - innoviHealth

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 who may report evaluation and management ...

Apr 12th, 2018

Billing Nutrition Counseling in a Chiropractic Setting

by Wyn Staheli, Director of Content - innoviHealth

Mar 29th, 2018

Medicare Telemedicine Changes for 2018

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below. Originating Site Fee Each ...

Mar 13th, 2018

CPT Code for DOT exams

by Wyn Staheli, Director of Content - innoviHealth

Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?

Mar 13th, 2018

When is 97112 Neuromuscular Re-education Billable?

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

Feb 1st, 2018

Medicare Requiring Modifier GP on Physical Therapy Services

by Wyn Staheli, Director of Content - innoviHealth

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 (emphasis added): Services furnished under the Outpatient ...

Feb 1st, 2018

Multiple Diagnostic Imaging Payment Reduction

by Wyn Staheli, Director of Content - innoviHealth

CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...

Feb 1st, 2018

Traumatic Subluxation Coding Controversy

by Wyn Staheli, Director of Content - innoviHealth

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 ...

Jan 31st, 2018

Q/A: Can I Perform 2 Untimed Codes at the Same Time?

by Wyn Staheli, Director of Content - innoviHealth

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)?

Jan 15th, 2018

Billing with a GP Modifier

by Wyn Staheli, Director of Content - innoviHealth

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?

Jan 15th, 2018

Medicare Requiring Specific Modifiers on Therapy Services

by Wyn Staheli, Director of Content - innoviHealth

Jan 9th, 2018

Should ROM Testing be Reported with Evaluation and Management Services?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

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.

Oct 31st, 2017

Correct Coding for Group Therapy

by David Klein, CPC CPMA CHC

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.

Oct 23rd, 2017

Summary of OIG Reports for Chiropractic

by Wyn Staheli, Director of Content - innoviHealth

The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...

Oct 20th, 2017

What is the Best Code to use for PNF Stretching of the Hamstrings and Glutes?

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

What is the best code to use for PNF stretching of the hamstrings and gluts? The doctor is currently using 97112.

Oct 13th, 2017

So, How Do You Decide if a Service was Provided?

by David M. Glaser, JD

An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism.....

Oct 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 CMCO CPCO CCCPC CPMA QCC

Do we need to charge for non-covered services performed under a maintenance visit if we use the S8990 code when billing Medicare?

Sep 30th, 2017

Annual Wellness Visit & Health Risk Assessment

by Find-A-Code™

Coding tips regarding Annual Wellness Visit and Health Risk Assessments

Sep 14th, 2017

Double Dipping in the History of the Evaluation and Management Note

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history. The subcomponents of history include: Chief Complaint ...

Aug 17th, 2017

Quick Tip from the HelpDesk -- Code 97140

by ChiroCode™

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. ...

Aug 8th, 2017

Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?

by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

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?

Aug 4th, 2017

Proposed Telehealth Changes for 2018

by Wyn Staheli, Director of Content - innoviHealth

Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers. Proposed Codes HCPCS code G0296 ...

Aug 1st, 2017

Annual Wellness Visit (AWV)

by Wyn Staheli, Director of Content - innoviHealth

Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.

Jul 28th, 2017

Auditing Vaccines

by Paul Chandler

Auditing vaccines can be difficult, as precise attention needs to be paid to the documentation to extract all variables needed for proper coding.

Jun 13th, 2017

Modifier GY for Chiropractic

by ChiroCode™

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?

Apr 28th, 2017

Can I be Forbidden from Billing 99204 or 99214?

by ChiroCode™

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?

Mar 24th, 2017

Are There any Alternatives for Code 97112 Neuromuscular Re-education?

by ChiroCode™

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.

Aug 3rd, 2016

Billing Units

by Wyn Staheli, Director of Content - innoviHealth

Are you billing units correctly? This article outlines important considerations to ensure that claims are submitted properly.

May 3rd, 2016

Using the SBIRT

by Wyn Staheli, Director of Content - innoviHealth

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.

Feb 1st, 2016

Will Incident-To in Your Organization Pass a Compliance Audit?

by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.

Aug 10th, 2015

Can Chiropractors Bill 99211?

by Melissa Hall

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 ...

Oct 22nd, 2014

Q & A: 97022 and Dry Hydromassage

by Jared Staheli, MPP

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 ...

Oct 16th, 2014

ABN FAQ for Chiropractic Care

by Jared Staheli, MPP

What is the ABN form used for? The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that the service(s) rendered to them are expected to not be covered. For chiropractic, reason for non-coverage is generally due ...

Sep 15th, 2014

Medicare Definition of Timed Codes

by Wyn Staheli, Director of Content - innoviHealth

Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Chapter 5 clarification included here.

Aug 26th, 2014

Q & A: What is the Definition of "New Patient" for Billing Evaluation and Management (E/M) Services?

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Q: What is the definition of "new patient" for billing evaluation and management (E/M) services? A: Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice ...

Jul 31st, 2014

Can Chiropractors Bill 99211?

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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. ...

Jul 31st, 2014

GP Modifier for Physio Therapy Services

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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 ...

Jul 24th, 2014

Are Medicare fees going up? Or down?

by Jared Staheli, MPP

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 ...

Jan 1st, 2014

Testing & Screening Tools

by Wyn Staheli, Director of Content - innoviHealth

There are numerous types of behavioral health screening tools for healthcare providers. Some, like the AUDIT and SBIRT are especially applicable to primary care providers caring for Medicare beneficiaries. This page includes some general information and resources for some of these screening tools. Let us know if you would like others included ...

Jul 8th, 2013

Denials for 97140 (Manual Therapy)? Here's the story.

by Jared Staheli, MPP

The ChiroCode Institute has received several inquiries over the last few months regarding a denial for 97140 (Manual therapy—such as myofascial release or trigger point therapy) when billed with 98940-98942 (Chiropractic Manipulative Treatment - CMT) on the same visit. Most payers follow Medicare’s guidelines for the use of this code, ...

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Feb 8th, 2022

Medicare Audit, Do-it-yourself

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Dec 18th, 2018

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

by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

May 16th, 2018

All About Knee Coding & Auditing

by Find-A-Code™

Total knee replacement now acceptable ASC procedure also, not auditing for a year. Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers.

Apr 12th, 2018

Evaluation and Management Coding and Auditing

by Find-A-Code™

Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).

Mar 29th, 2018

Coding and Auditing TeleHealth Services

by Find-A-Code™

Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.

Feb 2nd, 2017

How to Check NCCI Edits Using FindACode

by Find-A-Code™

How to Check NCCI Edits Using FindACode

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