Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

by | Last updated May 16, 2023 | Published on Feb 22, 2017 | Specialty Billing

Chiropractic Medical Billing
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Chiropractors diagnose and treat a wide variety of health conditions, including pediatric ailments, and can order lab and imaging studies, if required. With code updates and changing reimbursement rules, proper revenue cycle management support is crucial for these healthcare professionals. As a reliable provider of medical billing services, we recently highlighted the importance of proper documentation for success with chiropractic medical billing.

Chiropractic care is considered a good option for work-related musculoskeletal injuries, especially back pain. Besides spinal manipulation, treatment plans may include soft tissue work, rehabilitative exercises, physical therapy, and nutritional lifestyle counseling. A new study published in the Journal of Occupational Rehabilitation further strengthens this view. It says that workers who see a chiropractor first for a workplace injury gets back on the job faster. The findings of the September 2016 study from the University of Montreal are based on data from more than 5,500 injured workers in Ontario.

When it comes to payment, practitioners need to understand the nuances of chiropractic medical billing and coding which are quite different from that of other specialties. Medicare has special reimbursement rules, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which came into effect on April 16, 2015, includes provisions related to chiropractic services. According to the Centers for Medicare and Medicaid (CMS) chiropractic services, have the highest rate of improper payments for Medicare Part B services. Medical billing education is crucial to overcome this challenge. Here are some key points to note:

  • Specificity in documentation: Medicare Part B covers manual manipulation of the spine if medically necessary to correct a subluxation provided by a chiropractor. For appropriate reimbursement of this service, chiropractic claims should be billed correctly and accompanied by documentation of medical necessity. This means that the documentation must specify the exact location of the subluxation. For instance, if the location is the occiput vertebrae in the neck, reference must be made to the exact bones that are out of place or the subluxation should be specified by mentioning the exact area or set of vertebrae that are out of place.
  • Pre-payment authorization review: Starting 2017, chiropractors who fail to meet documentation and billing specifications will face pre-payment authorization review. Payers, including Medicare, scrutinize practitioners whose billing patterns do not meet predetermined norms and have documentation error rates of 85% or higher. Erring providers will be placed on a prepayment audit review in order to justify payment based upon a review of the medical records. Opting for medical chart audit services is a good strategy to avoid prepayment audit review. Medical chart review will ensure that all the information in the patient’s medical chart is complete and accurate and supports the code submitted.
  • ICD-10 chiropractic code deletions and additions for 2017: Starting October 1, 2016, five ICD-10 chiropractic codes were deleted and several new ones added. For instance, the new ICD-10 codes in the M.50 category for 2017 include:
    • M50.0 Cervical disc disorder with myelopathy
    • M50.1 Cervical disc disorder with radiculopathy
    • M50.2 Other cervical disc displacement
    • M50.3 Other cervical disc degeneration
    • M50.8 Other cervical disc disorders
    • M50.9 Cervical disc disorder, unspecified

For each of these ICD-10 codes, there are codes that indicate the diagnosis in greater detail for high cervical region, mid-cervical region, and at C4-C5 level, at C5-C6 level, and at C6-C7 level. The 2017 ICD-10-CM codes are effective for patient encounters starting from October 1, 2016 through September 30, 2017.

Chiropractors need to update themselves on the new codes and alter their billing practices to the dynamic payer environment. Not doing so will leave revenue on the table and also attract payer scrutiny. Fortunately, efficient physician billing services are available to chiropractors implement the new codes, reduce error rates, achieve compliance and maximize revenue.


Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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