Chiropractic Billing Tips for Reporting Musculoskeletal Disorders

by | Last updated May 16, 2023 | Published on Jul 5, 2022 | Specialty Billing

Musculoskeletal Disorders
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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 bill 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.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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