As a holistic therapy for various musculoskeletal conditions, the demand for chiropractic care is growing. Chiropractors use a range of manipulative techniques to reduce pain, improve function and enhance mobility in the body. However, there are very specific codes and billing rules to report these specialized services. Using the services of a chiropractic medical billing expert is recommended to convey the right message to payers, avoid audits, and maximize revenue. An experienced medical billing company would be knowledgeable about how to ensure chiropractic billing, coding, and compliance with the most current guidelines. In fact, in 2020, chiropractic practices need to be ready for certain coding changes.
Chiropractic CPT Code Changes for 2020
According to findacode.com, the CPT code changes impacting chiropractors that will take effect January 1, 2020, are as follows:
- Code 90911 replaced with two new codes: Currently, there are two pure biofeedback codes, 90901 and 90911. Code 90901 Biofeedback training by any modality will remain unchanged. Code 90911 Pelvic floor training for the treatment of incontinence has been deleted and replaced with two new codes, which also have changes to official reporting guidelines.
- Two new codes to report dry needling: The AMA CPT Editorial Panel approved two new CPT codes to report dry needling of musculature trigger points in 2020. The new codes are:
- 205X1, needle insertion without injection, 1 or 2 muscles.
- 205X2, needle insertion without injection, 3 or more muscles
The AMA has also added new guidelines for code 97140 Manual therapy techniques, e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction, 1 or more regions) and acupuncture codes (97810-97814) to use the new codes for “dry needling or trigger point acupuncture.
- Nine new codes and guideline changes for Health and Behavior Assessment/Intervention: The following health and behavior assessment codes have been replaced with nine new codes, along with major changes to guidelines:
- 96150 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment
- 96151 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment
- 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual
The new codes break out the services into individual, group, and family services, and include time based reporting with add-on codes as well as definitions of both an assessment and an intervention.
- New Category III codes for Health and Well-being Coaching: The American Medical Association notes: “Health and well-being coaching is a patient-centered approach wherein patients determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach”.
New category III codes have been introduced for specially-trained non physicians to help a patient achieve better health:
- 0591T Health and Well-Being Coaching face-to-face; individual, initial assessment
- 0592T individual, follow-up session, at least 30 minutes
- 0593T group (two or more individuals), at least 30 minutes
These services cannot be reported with the Health and Behavior Assessment/Intervention codes.
- Muscle testing procedure codes deleted: The CPT codes 95831-95834 that identify manual muscle testing procedures have been deleted. CPT guidelines recommend using 97161-97172 Evaluation and re-evaluation of a patient by a physical therapist, occupational therapist, and athletic trainer,instead. There is no change in the range of motion codes.
- Online evaluation codes replaced: Codes online medical evaluations 99444 (for physicians) and 98969 (for nonphysicians) have been replaced for 2020. The new codes and their associated guidelines include exclusions as to when these codes can and cannot be used.
According to www.find-a-code.com, the biggest issue that providers will need to avoid is the potential for over-reporting or “double dipping”. For e.g., if there is an E/M visit within 7 days before or after an online evaluation, these codes cannot be reported separately because the service is considered part of the E/M service. Reporting them separately would be considered “double dipping”.
The year 2020 will not bring any significant changes to the ICD-10 codes that chiropractors frequently use. However, one noteworthy change is the addition of a new guideline for growth plate fractures in Section 19.c of the Official ICD-10-CM Coding Guidelines:
3) Physeal fractures: For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.
Expert Medical Billing Services to File Correct Claims
Chiropractic medical billing is different from billing for other specialties, and often, much more challenging. Medical billing outsourcing companies that specialize in chiropractic medical billing and coding keep track of coding updates and reporting guidelines. They can help providers file correct claims to boost revenue and get paid sooner.