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Outsourced chiropractic billing services are essential to ensure all aspects of the billing are taken care of. Documentation skills and experience are needed for efficient medical billing and coding. Supporting documentation proves the need for the treatment being billed. It must therefore accompany billing codes to ensure the physician or practice receives reimbursement for the manipulation performed. The documentation for CMT (chiropractic manipulative treatment) must clearly include information supporting the requirement for the particular level of manipulation reported.

The exact bones may have to be listed or the area may have to be reported if only certain bones are implied. For reporting CMT to payers contracted to HNS, the subluxations need to be demonstrated by X-ray or physical examination. Each has specific documentation requirements.

Indicating Subluxation

For indicating subluxation on the basis of physical examination, it is mandatory to meet the asymmetry/misalignment criterion or abnormality of range of motion criterion. Along with either of these, one of the following two criteria also needs to be met:

  • Pain/tenderness indicated in terms of quality, location and intensity
  • Tissue changes felt in the characteristics of associated or contiguous soft tissues including muscle, ligament, skin and fascia

Remember that no matter how many manipulations get performed in a particular spinal region such as thoracic, cervical, etc, it always counts as a single region in the CMT codes.

CPT Codes

Here are the CPT codes for spinal chiropractic manipulative treatment:

  • 98940 – spinal, one to two regions
  • 98941 – spinal, three to four regions
  • 98942 – spinal, five regions

The five spinal regions are cervical, thoracic, lumbar, sacral and pelvic:

  • Cervical – manipulations to atlanto-occipital joint C1-C7 during any visit
  • Thoracic – manipulations to T1-T12 during any visit, posterior ribs involving the costovertebral and costotransverse joints
  • Lumbar – manipulations to L1-L5 during any visit
  • Sacral – manipulations to any part of the sacrum on any visit, including manipulation on the sacrococcygeal junction
  • Pelvic – manipulations to the sacroiliac joints as well as other pelvic articulations

Extraspinal Manipulations

  • 98943 – Extraspinal manipulations involving more than a single region

The following are the five extraspinal regions:

  • Head – manipulations, including TMJ, to the head but excluding atlanto-occipital joint
  • Rib cage – manipulations carried out to the anterior rib cage excluding the costovertebral and the costotransverse joints during any given visit
  • Abdomen
  • Upper extremities – manipulations to the shoulders, elbow, arm, hand and wrist during any visit
  • Lower extremities – manipulations to hip, knee, leg, foot and ankle on any visit

Make sure that the primary subluxation diagnosis and initial visit date of the existing claim condition are included. The appropriate HCPCS modifier must be used. The AT modifier must be used on a claim while providing active or corrective treatment for chronic or acute subluxation.

Outsourced chiropractic billing services can ensure that you don’t let documentation slip by. Accurate and comprehensive documentation ensures reimbursement from insurance payers.

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.

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