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Introduction:
Navigating the landscape of chiropractic billing requires a comprehensive understanding of procedure codes, diagnosis codes, and modifiers. In this blog post, we'll explore the essentials of these components and highlight the importance of modifiers in avoiding denials by insurance companies.
Procedure Codes:
Chiropractors utilize specific procedure codes to bill for the services they provide. Here are some commonly used procedure codes in chiropractic billing:
98940 - Chiropractic manipulative treatment (CMT); spinal, one to two regions
98941 - CMT; spinal, three to four regions
98942 - CMT; spinal, five regions
97014 - Application of a modality to one or more areas; electrical stimulation (unattended)
97140 - Manual therapy techniques; one or more regions
97110 - Therapeutic procedure; one or more areas, each 15 minutes; exercise
97112 - Neuromuscular reeducation of movement, balance, coordination, kin-esthetic sense, posture, and/or proprioception for sitting and/or standing activities
97124 - Massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion)
Diagnosis Codes:
Diagnosis codes help identify the reason for the chiropractic visit and support medical necessity for the services provided. Here are some commonly used diagnosis codes in chiropractic practice:
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
M99.04 - Segmental and somatic dysfunction of sacral region
M54.2 - Cervicalgia
M54.50 - Unspecified low back pain
M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M99.89 - Other specified disorders of the musculoskeletal system and connective tissue
M99.9 - Biomechanical lesion, unspecified
Modifiers:
Modifiers provide additional information about the services rendered and can help prevent denials by insurance companies. Here are some modifiers commonly used in chiropractic billing:
25 - Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service
59 - Distinct procedural service
GP - Services delivered under an outpatient physical therapy plan of care
GY - Services that are statutorily excluded, do not meet the definition of any Medicare benefit, or are not otherwise covered
AT - Active treatment
GA - Waiver of liability statement on file
76 - Repeat procedure or service by the same physician or other qualified healthcare professional
77 - Repeat procedure or service by another physician or other qualified healthcare professional
Conclusion:
Incorporating modifiers into chiropractic billing practices is essential for accurately representing the services provided and avoiding denials by insurance companies. By understanding and utilizing modifiers effectively in conjunction with procedure codes and diagnosis codes, chiropractors can optimize reimbursement and ensure proper documentation of patient care. Stay tuned for more insights on enhancing chiropractic billing efficiency and maximizing reimbursement. Need Expert Assistance to Maximize Your Revenue?
Navigating the intricacies of chiropractic billing codes and modifiers can be complex. Whether you're a chiropractor or part of another medical practice, optimizing revenue streams through precise coding practices and strategic modifier application is crucial.
Our team specializes in assisting practices like yours in maximizing revenue through efficient billing practices. If you have questions about procedure codes, diagnosis codes, or modifiers, we're here to help.
Don't hesitate to reach out to us for further assistance or to discuss how we can support your practice in enhancing efficiency and maximizing revenue.
Contact us today at info@infozenrcm.com to learn more. Your success is our priority.
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