Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

Chiropractic Medical BillingChiropractors 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.

Chiropractic Medical Billing

Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

Documenting Tonsillitis with Specific ICD-10 Medical Codes

Documenting TonsillitisTonsillitis is inflammation of the tonsils most commonly caused by a viral or bacterial infection. Health professionals who treat this condition include pediatrician, family medicine physician, otolaryngologist (ear, nose, and throat, or ENT doctor) and nurse practitioner. Physician medical billing services for procedures like tonsillitis depend on accurate clinical documentation.

Tonsils are part of the lymphatic and immunologic system that act as filters by trapping germs that pass through the nose and mouth. They also produce antibodies that help fight infection. Though not usually a serious condition, it can be very uncomfortable and on rare occasions lead to a hospital visit. Symptoms may be milder for tonsillitis caused by a viral infection, but for a bacterial infection the symptoms will be more severe. Whether caused by virus or bacteria, complete clinical documentation for tonsillitis should include the cause, time parameter and instructional note indicating tobacco use or exposure to smoking.

Signs and symptoms of acute tonsillitis include fever, enlargement of the tonsils, difficulty swallowing, and enlargement of the regional lymph nodes. ICD-10 codes for acute condition include:

  • J03.00 Acute streptococcal tonsillitis, unspecified
  • J03.01 Acute recurrent streptococcal tonsillitis
  • J03.80 Acute tonsillitis due to other specified organism
  • J03.81 Acute recurrent tonsillitis due to other specified organism

The fifth character indicates whether the condition is acute (0) or acute recurrent (1). Additional codes from B95-B97 can be used along with J03.80 and J03.81 to identify the infectious agent.

Chronic tonsillitis is listed in category J35:

  • J35.01 Chronic tonsillitis
  • J35.03 Chronic tonsillitis and adenoiditis

The disease is recurrent, especially in children. For frequent episodes of tonsillitis, otolaryngologists may recommend tonsillectomy surgical procedure to remove the tonsils. Tonsillectomy can also treat other problems such as breathing problems related to swollen tonsils, frequent and loud snoring, bleeding of the tonsils and cancer of the tonsils. Otolaryngology medical coding can be complex as otolaryngologists have to look for specific codes for both surgical and nonsurgical services.

Surgical procedures can be documented with ICD-10-PCS codes such as:

  • 0CTP0ZZ Resection of Tonsils, Open Approach
  • 0CTPXZZ Resection of Tonsils, External Approach
  • 0CBP0ZZ Excision of Tonsils, Open Approach
  • 0CBP3ZZ Excision of Tonsils, Percutaneous Approach
  • 0CBPXZZ Excision of Tonsils, External Approach

Professional medical billing companies provide the service of an experienced team of AAPC – certified medical coders, who are skilled in CPT, HCPCS, and ICD-10 coding.

Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

October 1, 2016 Ends ICD-10 “Flexibilities” – Accuracy No Longer Optional

ICD-10 “FlexibilitiesCMS had granted healthcare providers, hospitals and medical coding companies a one-year grace period for ICD-10-coded medical claims. An ICD-10 coding flexibility policy was implemented last year specifically for the claims submitted to Medicare and Medicaid. As this code set is approaching its first year of implementation, CMS has announced the end of the given concession.

Before the implementation of ICD-10 on October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) and the AMA announced efforts to help physicians prepare for ICD-10. CMS issued guidance on certain flexibilities agreed by both the agencies for a year-long implementation period of ICD-10. As per the guidance, Medicare claims will not be audited or denied based on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.

An ICD-10 ombudsman was also established to help “receive and triage physician and provider issues.” Due to limited reports of issues, the organization has closed its ICD-10 Coordination Center, which included the ICD-10 ombudsman. Advanced payments were also authorized if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

It was also reported that an additional 5,500 codes will be added to the list by the end of this grace period. These new codes relate to devices, the addition of bifurcation as a qualifier, additional body parts, and codes related to congenital cardiac procedures and placement of intravascular neurostimulators.

According to CMS, “As of October 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. Many major insurers did not choose to offer coding flexibility; so many providers are already using specific codes.”

ICD-10 was implemented mainly because of the higher degree of detail that it allows to describe the services provided. Medical coding specialists should make sure to avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. However, when sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code. It is also crucial to check the coding on each claim to make sure that it aligns with the clinical documentation.

While moving to an era of more strict usage of these code sets, physicians should be careful to choose a medical billing company that adheres to updated CMS guidelines.