CHIROPRACTIC BILLING AND CODING CHEAT SHEET – A REFERENCE GUIDE

 

Creating a cheat sheet for chiropractic billing can be helpful for keeping track of key codes and guidelines. Chiropractic billing often involves using Current Procedural Terminology (CPT) codes, International Classification of Diseases (ICD) codes, and modifiers. Here's a basic chiropractic billing cheat sheet:

 

 

CHIROPRACTIC BILLING AND CODING CHEAT SHEET – A REFERENCE GUIDE

 

CPT Codes:

 

1. Initial Evaluation and Management:

• 99201-99205: Office or other outpatient visits for the evaluation and management of new patients.

 

2. Subsequent Evaluation and Management:

• 99211-99215: Office or other outpatient visits for established patients.

 

Chiropractic Manipulative Treatment (CMT):

• 98940: CMT, 1-2 regions.
• 98941: CMT, 3-4 regions.
• 98942: CMT, 5 regions.

 

Note: These codes may be further modified based on the specific regions treated (e.g., cervical, thoracic, lumbar).

 

X-ray Services:

• 72010-72040: Radiologic examination, spine (e.g., X-rays of the cervical, thoracic, or lumbar spine).

 

Physical Medicine and Rehabilitation:

• 97010: Hot or cold packs therapy.
• 97110: Therapeutic exercises.
• 97112: Neuromuscular reeducation.
• 97140: Manual therapy techniques.
• 97530: Therapeutic activities.

 

Modalities:

• 97012: Mechanical traction therapy.
• 97014: Electrical stimulation therapy (unattended).
• 97032: Electrical stimulation therapy (attended).
• 97035: Ultrasound therapy.
• 97124: Massage therapy.

 

Other Services:

• 99070: Supplies and materials (e.g., orthotics, braces).
• 99078: Group therapy.
• 99140-99150: Special reports, such as narrative reports or medical-legal reports.

 

Evaluation and Management of Neuro-Musculoskeletal Disorders:

• 99201-99215: Office or other outpatient visits.
• 99241-99245: Office consultation.

 

Billing Codes for Medicare:

• G0283: Electrical stimulation (unattended), per session.
• G0281: Electrical stimulation (attended), per session.
• G0288: Electrical stimulation (manual), per session.

 

ICD-10 Codes:

• M54.5: Low back pain.
• M99.01: Segmental and somatic dysfunction of cervical region.
• M99.02: Segmental and somatic dysfunction of thoracic region.
• M99.03: Segmental and somatic dysfunction of lumbar region.

 

Modifiers: 

• -AT: Active treatment. Used to indicate that the service provided is a chiropractic manipulative treatment.
• -59: Distinct procedural service. Used when billing multiple procedures on the same day to indicate that they are separate and distinct.

 

Billing Tips: 

• Ensure accurate and detailed documentation for each patient visit.
• Verify insurance coverage and collect co-pays or deductibles at the time of service.
• Submit claims promptly to avoid billing delays.
• Use electronic billing when possible for faster processing.
• Stay updated with the latest coding and billing regulations.

 

Common Rejection Reasons: 

• Missing or incomplete patient information.
• Incorrect or invalid codes.
• Lack of medical necessity documentation.
• Duplicate claims.
• Timely filing limits exceeded.

 

Medicare Billing: 

For Medicare patients, use the AT modifier (-AT) to indicate active treatment.

Bill with the appropriate CMT code based on the number of spinal regions adjusted.

 

Remember that chiropractic billing regulations may vary by location and payer, so it's crucial to stay informed about specific requirements and updates in your area. This cheat sheet serves as a general guideline, but it's essential to consult with your billing department, use up-to-date coding manuals, and refer to official payer guidelines for accurate billing practices in your practice.