The primary therapeutic procedure chiropractors provide is spinal manipulation/adjustment. Generally, chiropractic service reimbursements are limited to treatment by means of manual manipulation (using the hands) of the spine for correcting a subluxation. This subluxation of the spine should be proved by x-ray or physical examination. For billing purposes, the chiropractor has to specify the level of subluxation on the claim and list it as the primary diagnosis. The secondary diagnosis would be the neuromusculoskeletal condition necessitating the treatment. The corresponding diagnostic codes (ICD-9 codes) must be listed to substantiate medical necessity.
98940, 98941, 98942 are the chiropractic manipulative treatment (CMT) codes describing the number of spinal regions receiving the manipulation. 98943 is the single extraspinal CMT code used by chiropractors to describe manipulative services for the head, rib cage, extremities, and abdomen. For due reimbursement, chiropractors need to report these manipulations using the appropriate CPT manipulation codes.
98940 — Chiropractic manipulative treatment (CMT); spinal, one to two regions
98941 — Chiropractic manipulative treatment (CMT); spinal, three to four regions
98942 — Chiropractic manipulative treatment (CMT); spinal, five regions
98943 — Chiropractic manipulative treatment (CMT); extraspinal, one or more regions
How Are Chiropractors Reimbursed?
Chiropractors are reimbursed for their services in different ways. Medicare provides payment only for these codes, whereas there are commercial insurance companies that reimburse a global fee. In the latter case, chiropractors are allowed a certain dollar amount for each visit, irrespective of the services provided or the CPT codes billed. Chiropractors may also bill for modalities apart from the manipulation and office visit codes, these modality codes range from 97010 – 97530, which again are reimbursed by some insurance companies.
The codes differ with a new patient and an established patient-new patient billing codes range from 99201-99205 and established patient codes are from 99211-99215. Sometimes chiropractors may have to bill an E&M service along with a CMT on the same day. Chiropractors can bill a separate E&M code on occasions such as visit of a new patient, or an established patient presenting with a new injury, re-injury/recurrence, exacerbation, or for a re-evaluation to decide whether any modification in the treatment plan is required. When billing your services, your exam is to be coded correctly, and then Modifier -25 has to be added under the modifier section. This will clarify that the medical examination was a service distinct from your therapeutic manipulation procedure and therefore should be paid in addition to the adjustment. Medicare does not reimburse chiropractic maintenance therapy.
Other Services a Chiropractor May Bill
Physical medicine modalities a chiropractor may report include supervised and constant attendance modalities. Supervised modalities do not demand personal contact with the healthcare provider, and are eligible only once per date of the service. Constant attendance modalities are time based and require direct individual contact with the service provider. Chiropractors may also report therapeutic procedures; these are time based and require direct contact with the service provider.
Importance of Accurate Documentation
Accurate documentation is important if one is looking for easy and timely reimbursement. Insurance payers need to be convinced of factors such as:
• The site where service was provided
• The medical necessity and appropriateness of the diagnostic and/or therapeutic services provided
• That the services provided are all correctly reported
Proper documentation would validate the claim(s) submitted to Medicare for reimbursement of services. Chiropractors should ensure that the documentation is in keeping with the clinical descriptors and definitions contained in CPT. It should be accepted by clinicians generally as well as interpreted and applied uniformly by users throughout the country.
A Thorough Knowledge of Coding Essentials Is Vital
Experienced medical coders with expertise in inputting chiropractic codes and modifiers can be of great assistance to practicing chiropractors. They can efficiently match chiropractic ICD-9 Codes to the appropriate chiropractic CPT codes in order to prove medical necessity. They will ensure that your claims are not rejected due to incorrect chiropractic medical coding, and enable you to get the payments due to you in a timely manner.
