Chiropractors treat a variety of musculoskeletal conditions, especially those affecting the spine. Complete documentation, supported by efficient chiropractic billing services, can help providers communicate diagnosis, treatment, and results on claims for proper reimbursement.
Musculoskeletal Conditions that Chiropractors Treat
Chiropractic therapy, which involves manipulating the spine or other parts of the body, can help reduce pain and discomfort associated with a variety of musculoskeletal conditions. The conditions that chiropractors treat include but are not limited to:
Carpal tunnel syndrome
plantar fasciitis
Epicondylitis
Sprains and strains
Tendinitis
Fractures
Ligament injuries
Myelopathy
Whiplash
Stroke
Dislocation
Frozen joints
Muscle, joint, or ligament tears and pulls
Herniated discs
Scoliosis
Osteoarthritis
Ruptured discs or tendons
Dislocation
Tips for Billing Chiropractic Therapy
Reporting diagnosis and treatment of musculoskeletal conditions on claims can be complex as there are many codes and considerations involved.
ICD-10 coding: Follow ICD-10 coding guidelines. A basic rule of diagnosis coding is to code findings to the highest degree of specificity. If a complicating factor exists, this should also be coded and placed at the end of the diagnosis list. Understand the guidelines for ICD-10 coding of musculoskeletal conditions. Report diagnosis using the appropriate codes in the ICD-10 code range M00-M99 – Diseases of the musculoskeletal system and connective tissue (Chapter 13). It’s also necessary to know the guidelines related to codes in Chapter 19 – Injury, poisoning and certain other consequences of external causes.
Site and laterality
Most of the codes in Chapter 13 have site and laterality designations to represent the bone, joint, or muscle involved.
When the condition involves more than one site, such as for osteoarthritis, use the appropriate “multiple sites” code. If a “multiple sites” code is not available, multiple codes should be reported to indicate all of the different sites involved.
Bone vs. joint
In some conditions, such as osteoporosis, M80, M81, the bone is affected at the lower end. Though the part of the bone affected is located at the joint, the site of the condition is the bone, not the joint. Acute traumatic vs. chronic or recurrent musculoskeletal conditions
Many musculoskeletal conditions are the result of previous injury or trauma or recurrent conditions. Chronic or recurrent injuries are generally reported using Chapter 13 codes. Bone, joint, or muscle conditions resulting from healed injuries as well as most recurrent bone, joint, or muscle conditions are found in Chapter 13.
Current, acute injuries should be reported using the appropriate injury code from Chapter 19.
In addition to the musculoskeletal condition code, certain codes in Chapter 13 may need external cause codes to help identify the underlying cause for the condition.
Reporting Pathologic Fractures: A pathological or fragility fracture is defined as “a fracture sustained due to trauma no more severe than a fall from standing height, with the break occurring under circumstances that would not cause a fracture in a normal, healthy bone”.
A seventh character is required for coding of pathologic fractures.(A, Initial encounter; D, Subsequent encounter; S, Sequela). The other 7th characters, listed under each subcategory in the Tabular List, should be reported for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae.
Care for complications related to fracture repair surgery during the healing or recovery phase should be reported using the appropriate complication codes.
Billing CPT Codes: Know how to report the CPT codes for chiropractic manipulative treatment (CMT). Chiropractors use four CPT codes for CMT based on the spinal regions treated:
CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
CPT Code 98941… Spinal, 3-4 regions
CPT Code 98942… Spinal, 5 regions
CPT Code 98943… Extraspinal, 1 or more regions
Code 98943 is not covered by Medicare.
When billing CMT, make sure to include the following in the claim:
The primary diagnosis of subluxation
The initial visit or the date of exacerbation of the existing condition
The appropriate CPT code that best describes the service
Make sure the documentation references the proper number of spinal regions per code.
Use the appropriate modifier: In addition to the CMT codes, chiropractors use a wide range of codes to report treatments and appointment types. If the CPT code requires a modifier and it is not included on the claim, the insurance company will deny the claim. The commonly used modifier codes for chiropractors are:
25: “significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service”
59: “a procedure or service was distinct or independent from other non-E/M services performed on the same day”
Musculoskeletal Evaluation and Management Coding: When documenting a patient encounter, providers can choose medical decision-making (MDM) or time as the primary element. The level of E/M service coded must be supported by the complexity of the problem, the care provided, and the documentation of the encounter.
To billing chiropractic services correctly, it’s important to stay up to date with the latest codes and guidelines and monitor Centers for Medicare & Medicaid Services (CMS) changes. In the rapidly evolving scenario, this can be challenging. Outsourced medical billing and coding services can help. Chiropractic medical billing companies have experienced coders and billing specialists who are up to date with the latest codes, billing guidelines, and payer reimbursement policies. They will query the provider if it is difficult to determine the best code to report a condition. Partnering with an expert can help practices avoid audits, ensure accurate claim submission,and increase revenue.
Hyperlipidemia (also called high cholesterol) refers to elevated levels of fats (lipids such as cholesterol and triglycerides) in the blood. Generally, our body requires adequate amounts of fats to build healthy cells. However, high levels of cholesterol can result in fatty deposits in the blood vessels, which in turn may result in blockage of the free flow of blood through the arteries.
About 94 million people over age 20 are estimated to have elevated total cholesterol levels. This amounts to about 50 percent of all U.S. adults. If left undiagnosed or untreated, the clogged arteries can trigger heart attack, stroke, or lead to other serious problems. People with untreated hyperlipidemia are twice as likely to develop coronary artery disease (CAD) as those with cholesterol levels in the normal range. Although high cholesterol levels can be inherited, it is most often the result of lifestyle factors like an unbalanced diet and reduced physical activity.
Therefore, incorporating key lifestyle and dietary options can help treat and prevent hyperlipidemia in an effective manner. Billing and coding for this condition is challenging due to the complexity of the codes and other related terminologies. Medical billing and coding companies can accurately assign the medical codes and ensure timely submission of your medical claims.
Symptoms of Hyperlipidemia
Generally, people with hyperlipidemia do not experience any specific symptoms until the condition has reached an advanced stage when people experience emergency complications, such as a heart attack or stroke. However, those with familial, or inherited hyperlipidemia, may develop certain symptoms such as – yellow, fatty growths around the eyes or joints.
Diagnosis involves a blood test called a lipid panel or a lipid profile. The physician will use the lipid panel to make a hyperlipidemia diagnosis. The Centers for Disease Control and Prevention (CDC) recommends that every person get a cholesterol test starting at the age of 20. In certain cases, cholesterol test may be appropriate for children and adolescents.
The CDC points out that 1 in 5 adolescents have high cholesterol in the United States. Physicians will recommend a cholesterol test for a child – if their family has a history of early heart attacks or heart disease, if a child has excess weight/obesity or diabetes. Incorporating key lifestyle changes is the first line of treatment for hyperlipidemia. Key lifestyle changes include – consuming a heart-healthy diet, doing regular exercise, quitting the habit of smoking, and maintaining a healthy body weight. In certain cases, if changes do not reduce the cholesterol levels, physicians may prescribe medications.
ICD-10 Codes for Hyperlipidemia
E78 Disorders of lipoprotein metabolism and other lipidemias
E78.0 Pure hypercholesterolemia
E78.00 Pure hypercholesterolemia, unspecified
E78.01 Familial hypercholesterolemia
E78.1 Pure hyperglyceridemia
E78.2 Mixed hyperlipidemia
E78.3 Hyperchylomicronemia
E78.4 Other hyperlipidemia
E78.41 Elevated Lipoprotein (a)
E78.49 Other hyperlipidemia
E78.5 Hyperlipidemia, unspecified
E78.6 Lipoprotein deficiency
E78.7 Disorders of bile acid and cholesterol metabolism
E78.70 Disorder of bile acid and cholesterol metabolism, unspecified
E78.71 Barth syndrome
E78.72 Smith-Lemli-Opitz syndrome
E78.79 Other disorders of bile acid and cholesterol metabolism
E78.8 Other disorders of lipoprotein metabolism
E78.81 Lipoid dermatoarthritis
E78.89 Other lipoprotein metabolism disorders
E78.9 Disorder of lipoprotein metabolism, unspecified
Hyperlipidemia is treatable and complications can often be avoided. Heart-healthy lifestyle changes can reduce cholesterol levels in the long run. Regular physical activity combined with a healthy diet can improve the balance of cholesterol in the blood and thereby prevent related health problems.
Healthcare providers need to be well-informed about the specific ICD-10 codes to report hyperlipidemia. Medical billing outsourcing services provided by AAPC-certified coders can help physicians optimize reimbursement for the services they offer.
Chiropractors treat a wide variety of conditions such as back pain, neck pain, herniated discs, sciatica, pinched nerves, and migraine as well as complex conditions. Many practices rely on Chiropractic Billing Services to report diagnosis and treatment accurately on claims. When it comes to billing and coding complex chiropractic conditions, proper documentation and using the right coding practices are essential to tell the whole story, communicate the findings, and prove medical necessity. Changes in the Evaluation and Management (E/M) rules and ICD-10 codes have made it easier for chiropractors to report complex conditions to insurers.
Office/Outpatient E/M Codes (newpatient): In 2021, coding guidelines for outpatient E/M services were revised with the result that patient codes 99202-99205 do not require the 3 key components –patient history, clinical examination, and medical decision making (MDM) — or reference typical face-to-face time. Effective 2021, each of the services includes a “ medically appropriate history and examination,” and code selection is based on the level of MDM or total time spent on the date of the encounter. The provider can now document medically necessity to establish a diagnosis, evaluate the status of a condition, and recommend the appropriate treatment option.
ICD-10 codes to report complex conditions to the highest level of specificity: ICD-10 coding allow for specificity.
ICD-10 codes can indicate if the condition is on the right side or the left and if the condition is chronic or acute.
ICD-10’s seventh character is an extension that allows for documenting the phase of care for injuries and other conditions with external causes. The extension will indicate if the patient is in the active phase of care, the rehabilitation or healing phase, or is suffering from a sequela of the injury.
Providers can report all diagnosis codes that identify the patient’s condition to the highest degree of specificity.
By reporting the patient’s co-morbidities that impact their current diagnosis, chiropractors can demonstrate the necessity of the level of care provided for the complex condition.
Documentation: History, subjective complaints and objective findings should be clearly documented. This will allow the medical coder to assign specific diagnosis codes to describe the patient’s condition. For e.g., M54.2 Cervicalgia, M47 Spondylosis, and M54.5 Lumbago are non-specific ICD-10 codes commonly used in the chiropractic office. By documenting the reasons for the back or neck pain, more specific codes can be assigned to better report the patient’s health condition.
An article on chiroeco.com offers the following guidance on documenting complex chiropractic conditions:
After conducting an examination, if it is decided that X-rays should be taken due to the presenting condition, the ordering and analysis of the X-rays would be considered in the complexity of the data to be reviewed and analyzed.
Ordering and prescription of proper custom orthotics would also be documented in the medical decision-making.
The nature of the mechanism of injury, the treatment options and the diagnoses are documented and if all these factors are rationally related in complexity, the care is considered to be medically necessary.
Order and placement of codes: When a chiropractor reports multiple diagnoses, the order of the codes will also impact claim adjudication, in addition to using the codes to their highest specificity. For instance, Medicare instructs that the precise level of the subluxation must be listed as the primary diagnosis. So, when required, segmental and somatic dysfunction (subluxation) codes (M99.1 – M99.05) should be always placed in the first position on the Medicare claim form. However, other commercial insurance and liability carriers may not require this. Sometimes, certain medical conditions are “complicated” by other disorders. In such situations, the order of the conditions present is crucial. The correct order in which they should be stated in the claim form is:
Neurologic conditions
Structural problems
Functional disorders
Complicating factors
Payer requirements: Changes and new requirements for Medicare and private insurance make chiropractic medical billing quite complex. In both cases, of course, chiropractors must provide evidence to support both standard and complex treatments. CMS guidelines state: “ The mere statement or diagnosis of “pain” is not sufficient to support medical necessity for the treatments. The precise level(s) of the subluxation(s) must be specified by the chiropractor to substantiate a claim for manipulation of each spinal region(s). There are five spinal regions addressed: cervical region (atlanto-occipital joint), thoracic region (costovertebral/costotransverse joints), lumbar region, pelvic region (sacro-iliac joint) and sacral region” (ref. CPT® Professional Edition 2017 p. 672). Further, Medicare guidelines state that a chiropractor must place an AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation, and that the Modifier AT must not be used when maintenance therapy has been performed.
Private insurers also have specific guidelines for coverage of chiropractic services. For e.g., Aetna considers chiropractic services as medically necessary when all of the following criteria are met:
– The member has a neuromusculoskeletal disorder.
– The medical necessity for treatment is clearly documented.
– Improvement is documented within the initial 2 weeks of chiropractic care.
Partnering with an experienced chiropractic medical billing company is the best way for chiropractic practices to report complex conditions correctly and avoid claim denials and audits.
Appropriate treatment and care are key to addressing urological disorders, which depends heavily on individual conditions. The duration of the treatment provided depends upon the gravity of the health condition. In comparison to other specialties, the coding and billing of urological disorders are intricate due to the complexity of the codes and terminologies. Medical billing and coding companies can accurately assign the medical codes and ensure timely submission of your medical claims.
Why error-free coding of urological disorders is important
Urology extends to other specialties such as oncology, gastroenterology, pediatrics, andrology, endocrinology, and gynecology. This makes it distinct and difficult to understand.
Mismanagement of the revenue cycle can occur when urologists have to focus on delivering excellent patient care and are hard-pressed for time
Urology procedures are typically costly. Underpayment or non-payment of urology services rendered can substantially impact the practice.
Health practitioners can have better control over the collections and denials of claims.
ICD-10 codes for common urological disorders
C61- Malignant neoplasm of prostate
N40.1- Benign prostatic hyperplasia with lower urinary tract symptoms
N13.8- Other obstructive and reflex uropathy
R33.9- Retention of urine, unspecified
R33.0- Drug-induced retention of Urine
R33.8- Other retention of urine
N20.0- Calculus of Kidney
N20.9- Urinary calculus, unspecified
N20.2- Calculus of kidney and ureter
N39.41- Urge incontinence
N43.40- Spermatocele epididymis, unspecified
N31.8- Other neuromuscular dysfunction of bladder
C67.9-Malignant neoplasm of bladder, unspecified
C67.0- Malignant neoplasm of trigone of bladder
C67.3 -Malignant neoplasm of anterior wall of bladder
CPT codes for urology surgeries
The CPT codes are assigned by categorizing them based on the organs like kidney, ureter, bladder, and urethra
50010-50593 – Surgical procedures on the kidney
50600-50980 -Surgical procedures on the Ureter
51020- 52700-Surgical procedures on the bladder
53000-53800-Surgical procedures on the urethra
A urology medical coding company can assist urologists to achieve a dynamic, denial-free revenue cycle by covering the most complicated portion of CPT codes. The coding process specifically addresses the nuances of urological disorders, and the services are affordable considering the quality, efficiency and turnaround time.
Pediatric rheumatology or juvenile arthritis is commonly found in children under the age of 16. The common form of juvenile arthritis is juvenile idiopathic arthritis (JIA). According to the National Library of Science, about 4-16 in 10,000 children in the United States are affected by juvenile arthritis. That is, approximately 294,000 children in the US get affected every year. Among these, more than half of the cases are reported as juvenile idiopathic arthritis. Even though the cause of this auto-immune disease is unknown, it can last lifelong in rare cases. As with any medical condition, timely and accurate medical documentation is vital for effective treatment and patient care. A medical coding outsourcing company that provides rheumatology medical coding can ensure error-free clinical documentation and reimbursement for physicians.
For an effective documenting claim, ICD-10 coding is necessary. The ICD codes for pediatric arthritis are as follows.
❖ M08 Juvenile arthritis
➣ M08.0 Unspecified juvenile rheumatoid arthritis
M08.00 Unspecified juvenile rheumatoid arthritis, of unspecified site
➣ M08.09 Unspecified juvenile rheumatoid arthritis, multiple site
For effective reimbursement, equal participation of physician and medical coder is necessary. The physician should enter all the details of the patient while preparing clinical documentation. These details include treatment information, clinical tests, medications and so on. The medical records should be appropriate and accurate. In case of pediatric rheumatic or juvenile arthritis, symptoms such as the following need to be documented clearly:
Stiffness
Limping
Difficulty in moving arms and legs
Decrease in level of physical activity
Fever
Swelling in joints
Clumsiness
Along with the symptoms, you should also mention the child’s family history, physical examination results, blood test and scan results as well as the type of arthritis the child has. The blood test and scanning would help you to identify the type of arthritis. The different types of juvenile arthritis include:
Oligoarthritis
Polyarthritis
Systemic
Enthesitis-related
Juvenile psoriatic arthritis
Undifferentiated
As the treatment is finalized based on the type of the arthritis, you should mention the variant of arthritis while documenting. The treatments for juvenile arthritis include:
Medication
Therapies
Surgeries
Exercise
The clinical documentation is translated into coding data by medical coders. So, physicians should enter data accurately in the medical records. Even a small mistake can prove very costly. The documentation should include the following details:
Site of disease or disorder
Encounter status of treatment
Associated conditions
Manifestations
Associated complications
Supporting information such as lab values, ICD-10 documentation
The medical coding industry witnesses changes frequently. Therefore, medical coders should stay informed regarding the changes, modifications, and deletions of medical codes.
To ease the medical billing process and ensure optimum reimbursement, physicians can rely on medical billing outsourcing companies that provide rheumatology medical coding. When outsourcing, you get to work with a team of knowledgeable and experienced medical coders who provide dedicated medical billing solutions.
