Chiropractic Care – Maximize Reimbursement with Appropriate Billing and Coding Practices for 2016

by | Last updated Dec 7, 2023 | Published on May 25, 2016 | Specialty Billing

Chiropractic Care
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As a form of alternative medicine that stresses non-invasive therapy for disorders of the musculoskeletal system, especially the spine, chiropractic care has gained much popularity in recent years.  However, with changing codes and the specific regulations that affect reporting care for this specialty, chiropractic billing can be quite complex. That’s why many chiropractors now rely on professional chiropractic billing services to avoid improper and out-dated billing and coding practices and to get the payment they deserve.

Proper coding is crucial to ensure accurate billing practices. Here are some of the key points that orthopedic practices need to consider in chiropractic coding:

  • Frequent CPT coding changes and revisions
  • Proper documentation and appropriate billing of codes for claims
  • Use of the most current diagnosis codes (ICD-10) related to the date of service
  • Coding of re-exams – updating the diagnosis coding for all new episodes, including a re-exam or an examination for a new issue
  • Use of modifiers – appending of an appropriate modifier to codes for reimbursement

Here are some key points to note with respect to coding for chiropractic care:

  • CPT code 97140: Selecting the CPT codes that most accurately identify the services performed is crucial. CPT code 97140 is reported for services that constitute manual therapy techniques and important considerations for reimbursement in this context include:
    • For reporting manipulative treatment which is a manual treatment, CMT codes (98940-98943) are usually the most accurate CPT codes to use.
    • When 97140 is reported on the same date as a CMT service, daily charting is needed to confirm the performance of separate and distinct services for different body regions.
    • Modifier-59 would need to be appended as a separate and distinct service during the same visit where any CMT procedural code is also recorded.
  • CPT Code 97010: Medicare regards CPT Code 97010 (hot/cold packs) as a “bundled” service. For bundled services, reimbursement for the code is clubbed with the reimbursement for another code. So services that fall under 97010 are considered a part of whatever primary service is rendered to the patient and cannot be billed separately.
  • ICD-10 specificity: Before ICD-10, most chiropractic offices generally used codes from a code set of about 50-75 codes. However, even this number of codes has multiplied several times under ICD-10. There are separate codes for myalgia (M79.2) and fibromyalgia (M79.7), and also codes for general muscle spasm (M62.838) and spasm of the back (M62.830). 13 describes cervical disc disorder with radiculopathy, cervicothoracic region. For extremities, codes can be designated for left and right.

Benefits of Chiropractic Medical Billing Services

AAPC-certified coders in established HIPAA-compliant medical billing companies are aware about the codes required for chiropractic medical billing as well as about the complexities that can lead to reimbursement or denial. They provide comprehensive services that cover patient enrolment, insurance verification and authorizations, coding, billing and reconciling of accounts and accounts receivable collections. Partnering with the right company can ensure cost-effective services to avoid billing errors and maximize 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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