Chiropractic Billing & Credentialing
Chiropractic billing does not incorporate very many CPT codes, but if the claims are not billed correctly it can be a very costly mistake for your practice. Medwave has a dedicated team of chiropractic billing experts in the Pittsburgh region that can help you and your office succeed in getting claims paid fast and efficiently.
The CPT codes for chiropractors range from Spinal Manipulation, Outpatient Therapy, Evaluation and Management (E&M), Orthotics, and X-rays. While there may not be that many to use, most of them will require the use of a modifier and correct documentation in order the get paid. Not appending the correct modifier to the CPT codes will cause the claim to deny which results in slower reimbursement from repeat and corrected claim submission.
A lot of times it will be necessary to submit your documentation to show exactly what treatment is being performed. Knowing how to document correctly by listing all regions affected and under active treatment can be the difference between the insurance company acknowledging that the treatment was done and coded correctly or denying for lack of medical necessity.
ICD-10 diagnosis codes should reinforce the documentation that you have done by showing the exact regions being treated. There should be at least one ICD-10 code per region treated. You can decide how many codes you need based on the spinal manipulation code(s) listed below. Under coding, your documentation will lead to denied claims or audits by the insurance company. It is also possible to be audited on the frequency and use of which CPT code you use. Excessive use of multiple region adjustments with poor documentation and incorrect ICD-10 coding can also lead to your practice being audited.
CPT + ICD-10
Use of CPT and ICD-10 codes together
- 98940 – Correct coding would require you to use 2-4 DX codes to support treatment
- 98941 – Correct coding would require you to use 4-8 DX codes to support treatment
- 98942 – Correct coding would require you to use 6-10 DX codes to support treatment
On top of correctly coding your CPT and ICD-10 codes, many insurance companies require the use of Modifiers to explain in better detail the level of care being provided.
- Modifier-25 must be used to identify an Evaluation and Management (E&M) code when it is performed on the same day as a spinal manipulation code.
- Modifier-59 must be used to identify a certain separate therapy service codes when used on the same day as a spinal manipulation code.
- Modifier-59 must be used to identify a separate spinal manipulation code when there are more than one regions being treated on the same day.
- Modifier-AT must be used on all spinal manipulation codes when billed to Medicare in order to show that the patient is under active treatment.
- Modifier-GA must be used with Medicare when an advanced beneficiary notice is on file and the provider knows the service performed will be denied.
Workman’s compensation, auto accidents and personal injuries can be a big part of chiropractic office’s case load. Having the correct information to send to the insurance company can become tricky and timely. It is important with these types of cases to find a direct point of contact with the insurance company and legal counsel involved. Staying informed on how the claim is proceeding is crucial to knowing how and when your practice will be reimbursed. Keep in mind; the insurance companies involved can forget about you, resulting in being left out of any settlement the patient may have.
Medwave and its team are up-to-date on the most current use of CPT codes, modifiers, ICD-10 coding and medical documentation. We educate you and your staff on the issues that affect your office the most so that we can work together to make your practice successful. Outsourcing your medical billing to dedicated professionals can take the stress out of bringing in consistent, reliable money for your practice.
Contact us today to speak with someone on how we can be an affordable asset to you and your chiropractic practice’s future in the Greater Pittsburgh region.