Best Chiropractic Billing Practices for Musculoskeletal Disorders

by | Last updated May 15, 2023 | Published on Oct 7, 2022 | Specialty Coding

Best Chiropractic Billing Practice
Share this:

Chiropractic treatment is concerned with addressing damage, disorder, and misalignment of the joints, particularly along the spine. Documentation of various musculoskeletal disorders is essential for avoiding claim denials. In addition, to address the challenges posed by the changing landscape of insurance companies’ and Medicare’s regulatory framework, physicians can rely on chiropractic billing services for a seamless billing workflow and revenue generation through the timely submission of claims.

Coverage of Chiropractic Services

The coverage of treatment offered under chiropractic services is of limited benefit. The coverage is limited to subluxation or manual manipulation of the condition. Subluxation refers to the condition wherein a spinal vertebra is out of position in comparison to other vertebrae.

The manual manipulation is done by following the guidelines of physical examination:

  1. Pain: The patient encounters are primarily based on a painful response from neuromusculoskeletal disorders. The tenderness and pain are found through observation, percussion, palpation, provocation, etc. The intensity of the pain is assessed by using one or more of the following: visual analog scales, algometers, pain questionnaires, etc.
  2. Asymmetry/misalignment: It is identified on a sectional or segmental level through the following: observation, static palpation for the misalignment of vertebral segments, diagnostic imaging, etc.
  3. Range of motion abnormality: This is diagnosed through motion, palpation, observation, stress diagnostic imaging, range of motion measurements, etc.
  4. Tissue/tone texture: It can be identified through the following procedures: observation, palpation, use of instruments, tests for length and strength, etc.

The problem/complaint addressed by the physicians and the precision levels of each subluxation treated has to be documented in the medical record. If the patient needs an extensive and prolonged course of treatment, it should be consistent with the reported diagnosis. The claim must be specified with the level of subluxation and has to be listed as the primary diagnosis. Refer to ICD 10 codes for the conditions that require medical necessity.

Chiropractic Billing Tips for Seamless Revenue Cycle Management

There are many codes and considerations involved while documenting musculoskeletal disorders which need intense focus to ensure accuracy.

  • Maintain the Highest Level of Specificity when Assigning ICD -10 Codes

Diagnosis coding requires the code findings to be documented with the highest degree of specificity. If the patient is having a complication factor with regard to musculoskeletal conditions, it has to be coded and placed at the end of the diagnosis list. This necessitates understanding the guidelines for ICD-10 coding of musculoskeletal conditions. Appropriate codes in the range of M00-M99 – Disease of the musculoskeletal system and connective tissue (chapter 13) must be reported. Besides, the guidelines pertaining to the codes mentioned in Chapter 19 (Injury, poisoning and certain other consequences of external causes.)

  • Represent Side and Laterality

The codes mentioned in chapter 13 have the site and laterality designations to represent the bone, joint, or muscle that is involved in the musculoskeletal condition. If the patient has damage or disorder in more than one site as that in osteoarthritis, make sure to use appropriate “multiple sites” codes. If there is an unavailability of multiple site codes, then use multiple codes corresponding to the different sites involved.

  • Analyze the Medical History of the Patient

This is a very crucial step in the billing of chiropractic musculoskeletal disorders as many disorders occur due to a previous injury or trauma or recurrent conditions. Chapter 13 codes are used for reporting chronic or recurrent injuries. This includes bone, joint, or muscle conditions resulting from healed injuries as well as most recurrent bone, joint, or muscle conditions. Chapter 19 appropriately code current and acute injuries. The underlying cause of the condition can be identified using external cause codes.

Why Should You Outsource?

A chiropractic medical billing company ensures that the claims are verified prior to submission. This can eliminate any errors in patient data, the eligibility of providers, and the insurance information of the patient. Expertise in complex medical billing processes can help physicians submit error-free claims which can reduce claim-denials drastically.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

More from This Author