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Chiropractic medical billing is not just the use of the familiar CPT codes 98940, 98941 and 98942. The appropriate modifier that describes the services, Medicare or any specific insurance guidelines, proper revenue cycle management, HIPAA compliance and on-time filing of claims all matters.

Documenting the healthcare services provided and submitting the claim is the normal medical billing process. But for chiropractors, something is different. So, what’s unique with chiropractic?

  • Adherence to Medicare Guidelines – Medicare is a separate entity and has a completely different and separate fee schedule and billing policy. Medicare only covers adjustments when performed by a chiropractor. Though they can refer for X-rays, Medicare does not cover exams, therapies or X-rays when performed by this specialist. Maintenance or non-active/non-acute adjustments are not covered.
    If there are reasons to suspect that the claim may get denied by Medicare,

    • Use Active Treatment (AT) Modifier. The AT modifier must be used on all adjustment codes, when the adjustment is performed as part of Active/Acute treatment. However, this modifier is not appropriate on treatments as part of maintenance care.
    • Advance Beneficiary Notification (ABN) must be signed by the patient. ABN is not to be signed for any other service than the adjustment.
    • GA modifier should be used, when a validly executed ABN is on file. This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare. Use of this modifier ensures that upon denial, Medicare will automatically assign the beneficiary liability.
  • Subluxation documentationMedical billing specialists must clearly understand the vocabulary related to chiropractic conditions. In order to get reimbursed by insurance for chiropractic services
    • The patient must have a significant health problem which makes it necessary for the chiropractor to use musculoskeletal manipulation as a therapeutic remedy
    • The patient must have a spinal subluxation, as determined by the physical examination or x-ray
    • The exact location of the subluxation must be clearly noted in the patient’s medical chart. These locations range from the occiput vertebrae in the neck to the sacral vertebrae and coccyx.
    • The patient must demonstrate at least two of the four symptoms of subluxation – pain/tenderness in a specific location, asymmetry/misalignment, and range of motion abnormality and tissue or tone changes in soft tissue. One always has to be either asymmetry/misaligned or range of motion abnormality.

Many insurance plans only cover a certain number of chiropractic services per person per plan year. And so, it is important for your chiropractic medical billing company to have extensive experience in handling the complexities presented by chiropractic billing and modifiers.

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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