Everyone knows denials and documentation requests reduce the value of your chiropractic claim and frustrate your billing department. To get paid on time and in full, be sure you avoid the following tasteless errors in your chiropractic coding and billing:
1. Modifier Failures. Depending on which policy code you use, a modifier may be appropriate. In Medicare, for example, you need to indicate whether the assistance represents Active treatment (using the modifier -At) or it will not be paid. Similarly, performing manual Therapy (97140) on the same visit as an adjustment will also wish a modifier to be present to signify that it was a cut off and unavoidable assistance (Modifier -59).
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2. Stagnant Adjustment Codes. Billing for a 5 region adjustment (98942) on every visit just because you are a full spine doctor will not sit well with most guarnatee companies. From the viewpoint of the guarnatee company, it is statistically thinkable, that every one of your patients needs an adjustment from top to bottom every visit.
3. Disposition Use of Full Spine X-rays. This is other easy red flag for an guarnatee business to spot and it follows the same logic as the former entry. If other practitioners all take x-rays in a wide range of anatomical regions, but every one of your x-rays is a full spine series, then you suddenly stand out from the rest of the pack and are essentially fascinating an auditor to investigate your billing and coding practices.
4. Billing for an E/M Code on a Daily Basis. Some shady chiropractic "coaches" and custom supervision gurus propose their clients to increase services through the repeated, Disposition (or even daily). Unfortunately, anything with a knowledge of permissible coding practices will tell you that this is not warranted and will just lead to big problem when the guarnatee business catches on.
5. Billing for all New Patients With a High Level E/M Code. Certainly, high level E/M codes such as 99204 or 99205 reimburse the most. But there are probably few (if any, in unavoidable chiropractic offices) times when an exam truly meets the criteria of these codes. To plainly bill these codes in hopes that it will fly under the radar is foolish and misguided at the least and possibly fraudulent as well.
Hopefully, this "red flag list" will serve as a reminder of some of the poor practices that will get you audited by a third party payer. If you are a chiropractic office that is of course utilizing one of the above billing or coding practices in your office, let this record be a warning that your current procedures have you headed for trouble. My advice would be to spoton any of the actions indispensable immediately and/or get experienced help quickly. There are many ways to get paid for your services through permissible chiropractic billing, coding and documentation; utilizing some of the above methods will only get you in problem over time.
5 base Chiropractic Coding & Billing Mistakes to Avoid
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