Chiropractic Billing for Dummies: What Chiropractic Billers Need to Know?

Like any other practice, chiropractors also need to adhere to the important set of codes called CPT codes. AMA maintains chiropractic CPT codes – American Medical Association and is regularized by the CMS across the chiropractic providers.

CPT codes are comprised of five alphanumeric typo scripts, that are used to evaluate, describe, and diagnose all the treatments rendered on patients by chiropractors. With this, one can have an idea of the CPT horizon. To be at the top, practices for chiropractic billing for dummies can be done to avoid errors and eliminate the chances of rejection.

Due to many CPT codes assigned for treatments and services, many practices are readily inclined toward outsourcing their chiropractic service to chiropractic billing services to reduce the rejection rate and diminish the chances of claim denials. Later in the article today, we’ll explore information about chiropractic billing and the use of CPT codes in chiropractic billing.

Chiropractic billing for dummies billing and CPT codes

Chiropractic billing for dummies billing and CPT codes
source:holisticbillingservices.com

CPT codes have three main categories for codes and treatments. However, chiropractors are obligated to use category one codes. Codes in this category identify the procedures performed by the physical healthcare providers executed for out and in-house patients. The most common codes at the chiropractic service include;

  • CPT Code 98940 – Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • CPT Code 99203 – Initial Exam
  • CPT Code 97110 – Therapeutic Exercise

Chiropractic Modifiers Codes

A range of modifiers can also be added to certain codes to evaluate some treatments in order to inform insurance companies that they are associated with specific treatments related to a medical condition.  It is important to inform insurance companies as additional modifiers in the billing without prior notice and explanation are often rejected.

In this case, two modifiers are there that are commonly used by chiropractors, they are 59 and 25. For maximum reimbursement, chiropractic billers need to understand the modifiers to use according to the recommendations of the payer. For example, if a chiropractor has provided a service and the biller doesn’t find the correct code, then adding a modifier to attach in order to evaluate the treatment would be added. Also, insurance companies should provide the codes for these added services.

Codes list for chiropractic practice

Billing codes are an essential component in the chiropractic billing process. These CPT codes are integral as they notify insurance companies about what procedure has been performed and what they are likely to reimburse for. By sharing CPT codes with insurance companies, they would be able to track the data and measure the health improvements by monitoring medical procedures rendered.

Medical health service providers other than chiropractors use a range of medical CPT codes to use for their services. However, chiropractors have a limited number of codes to use for billing. The chiropractic manipulative treatment has four common codes to use. These codes are based on the treatment of spinal medical procedures and treatments for the same region;

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
  • CPT Code 98943 Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions

When doing manipulation or adjustments for chiropractic billing, the documentation associated with the spinal region must refer to the accurate code. For instance, when a CPT code of 98941 is used in the billing documentation, it should reference the treatments for more than two or three spinal regions with misalignment or dysfunction. Once this code is used and only one or two spinal regions are documented, then it is likely possible that insurance companies would reject the claims.

The most commonly used CPT codes in chiropractic billing include;

Codes list for chiropractic practice
source:chirohealthusa.com
  • CPT Code 99202 – Evaluation and Management, Initial Visit
  • CPT Code 99203 – Evaluation and Management, Initial Visit
  • CPT Code 99204 – Evaluation and Management, Initial Visit
  • CPT Code 99212 – Evaluation and Management, Established Patient
  • CPT Code 99213 – Evaluation and Management, Established Patient
  • CPT Code 99214 – Evaluation and Management, Established Patient
  • CPT Code 97140 – Manual Therapy
  • CPT Code 97110 – Therapeutic Exercise
  • CPT Code 97750 – Physical Performance Examination
  • CPT Code 99211 – Re-evaluation
  • CPT Code 97112 – Neuromuscular Re-education
  • CPT Code 97530 – Therapeutic Activities
  • CPT Code 97010 – Hot/Cold Packs
  • CPT Code 97014 – Electrical Stimulation (Unattended)
  • CPT Code 97035 – Ultrasound/Phonophoresis
  • CPT Code 97161 – PT Evaluation: Low Complexity
  • CPT Code 97116 – Gait Training
  • CPT Code 97162 – PT Evaluation: Moderate Complexity
  • CPT Code 97535 – Self Care/Home Management Training
  • CPT Code 97032 – Electrical Stimulation (Manual)
  • CPT Code 97012 – Mechanical Traction
  • CPT Code 97113 – Aquatic Exercise
  • CPT Code 97124 – Massage
  • CPT Code 97018 – Paraffin Bath
  • CPT Code 97022 – Whirlpool
  • CPT Code 97026 – Infrared Light
  • CPT Code 97033 – Iontophoresis
  • CPT Code 97039 – Laser/Other
  • CPT Code 72020 – Radiologic examination, spine, single view, specify a level
  • CPT Code 72040 – Radiologic examination, spine, cervical; two or three views
  • CPT Code 72070 – Radiologic examination, spine; thoracic, two views
  • CPT Code 72072 – Radiologic examination, spine; thoracic, three views
  • CPT Code 72100 – Radiologic examination, spine, lumbosacral; two or three views
  • CPT Code 72170 – Radiologic examination, pelvis; one or two views
  • CPT Code 72190 – Radiologic examination, pelvis; complete, minimum of three views
  • CPT Code 72200 – Radiologic examination, sacroiliac joints; less than three views
  • CPT Code 72220 Radiologic examination, sacrum, and coccyx; minimum of two views

How can a billing service help chiropractors with CPT coding?

Outsourcing companies are experts in revenue cycle management and using chiropractic billing software which makes it easy to document claims using CPT codes. Claims are subjected to get cleared in one go from the clearinghouse as they are professional in using billing software and making reimbursement claims.

Turn your heads toward Sybrid MD today for complete and comprehensive chiropractic billing service.