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 common errors in your chiropractic coding and billing:
1. Modifier Failures. Depending on which procedure code you use, a modifier may be appropriate. In Medicare, for example, you need to indicate whether the service 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 require a modifier to be present to signify that it was a separate and distinct service (Modifier -59).
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 insurance companies. From the viewpoint of the insurance company, it is statistically improbable that every one of your patients needs an adjustment from top to bottom every visit.
3. Routine Use of Full Spine X-rays. This is another easy red flag for an insurance company to spot and it follows the same logic as the previous entry. If other practitioners all take x-rays in a wide variety 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 inviting 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 practice management gurus advise their clients to increase services through the repeated, routine (or even daily). Unfortunately, anyone with a knowledge of proper coding practices will tell you that this is not warranted and will just lead to big trouble when the insurance company 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 certain chiropractic offices) times when an exam truly meets the criteria of these codes. To simply 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 actually utilizing one of the above billing or coding practices in your office, let this article be a warning that your current procedures have you headed for trouble. My advice would be to correct any of the actions necessary immediately and/or get experienced help quickly. There are many ways to get paid for your services through proper chiropractic billing, coding and documentation; utilizing some of the above methods will only get you in trouble over time.
Tom Necela, DC, CPC is the President of The Strategic Chiropractor, a consulting firm dedicated to helping chiropractors maximize reimbursements and minimize their risk of audits by teaching sound billing, coding, documentation and collections strategies. If you’d like more information, go to http://www.strategicdc.com