Medical Billing

Top 5 CPT Codes and Modifiers for Chiropractic Medical Billing

For efficient reimbursement in chiropractic medical billing, highly accurate coding is essential. In this process, the use of Current Procedural Terminology (CPT) codes and modifiers is crucial. To achieve maximum reimbursement and compliant billing procedures, it is crucial for chiropractors and their billing team to understand the top 5 CPT codes and modifiers.

This article will look at the top 5 CPT codes for chiropractor medical billing. We will thoroughly review each code and modification, explaining its purpose, usage, and documentation requirements. By the conclusion of this tutorial, you should have a good idea of how to use these reimbursement codes and modifiers in the chiropractic billing methods.

Understanding CPT codes

CPT codes are standardized medical procedure codes that are used to describe a variety of healthcare services. They contribute to the consistency of medical billing and documentation among various healthcare providers. CPT codes developed expressly for chiropractic manipulative therapy (CMT) and other associated procedures are essential for chiropractors.

The Role of Modifiers and CPT Codes for Chiropractor Medical Billing

The Role of Modifiers and CPT Codes for Chiropractor Medical Billing
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Modifiers are two-digit codes that are used in combination with CPT codes to offer additional details about the service provided. They aid in the clarification of certain conditions or components of therapy. Modifiers should be used correctly to guarantee appropriate compensation and to avoid claim denials or delays.

CPT Code 98940: Chiropractic Manipulative Treatment (CMT) – Spinal, One to Two Regions

CPT Code 98940 denotes chiropractic manipulative therapy involving one to two areas of the spine. When a chiropractor makes spinal adjustments or manipulations on one or two particular locations of the patient’s spine, this code is utilized. Accurate documentation of the areas treated is required to demonstrate medical necessity.

CPT Code 98941: Chiropractic Manipulative Treatment (CMT) – Spinal, Three to Four Regions

CPT Code 98941 is used when a chiropractor provides chiropractic manipulative therapy on three to four areas of the spine. This code applies when the chiropractor modifies or controls three to four different areas of a patient’s spine. For accurate billing, accurate records of the affected locations are required.

CPT Code 98942: Chiropractic Manipulative Treatment (CMT) – Spinal, Five Regions

CPT Code 98942 is used for chiropractic manipulative therapy of the spine in five distinct locations. It is used when the chiropractor adjusts or manipulates all five sections of the patient’s spine. For effective reimbursement and compliance, detailed documentation of the operated regions is required.

CPT Code 97140: Manual Therapy Techniques

Manual treatment procedures done by a chiropractor are covered under CPT Code 97140. Hands-on approaches are used in manual therapy to improve musculoskeletal function. Soft tissue mobilization, myofascial release, manual lymphatic drainage, and joint mobilization are all possible. For billing purposes, accurate documentation of the precise approaches employed is required.

CPT Code 97014: Electrical Stimulation

Electrical stimulation delivered by a chiropractor is coded as CPT 97014. The use of electrical currents to activate nerves or muscles for therapeutic reasons is known as electrical stimulation. For correct invoicing and reimbursement, proper documentation of the precise parameters employed, such as frequency, duration, and waveform, is essential.

Commonly Used Modifiers for Chiropractic Medical Billing

Commonly Used Modifiers for Chiropractic Medical Billing
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Modifiers are used to enhance the specificity of the CPT codes regardless of the procedure and regulations. Some common modifiers in the CPT codes used in the chiropractic billing includes;

  1. Modifier -25: This modification is added to an Evaluation and Management (E&M) code to indicate that another service was performed on the same day as the E&M visit.
  1. Modifier -59: Modifier -59 is used to refer to a different procedural service when multiple procedures are conducted within the same session but are not usually reported together.
  2. Modifier -GA: This modifier indicates that the patient received an Advance Beneficiary Notice (ABN) for services that Medicare may consider non-covered.
  3. Modifier -GP: Modifier -GP is used to indicate that services were rendered under a physical therapy plan of care.
  4. Modifier -AT: This modifier indicates the service was provided by an assistant at the direction of the physician or therapist.
  5. Modifier -XA: Modifier -XA is appended to an Evaluation and Management (E&M) code to indicate a service provided during a Medicare-defined “Part A” setting.

Frequently Asked Questions

  • What are CPT Codes?

CPT code or The Current Procedural Terminology codes are referred to report the additional healthcare procedures provided. By applying these codes, documentation, and billing process across the healthcare providers creates uniformity.

  • How do modifiers affect Chiropractic Medical Billing?

Modifiers reserve additional information for the services provided at any level of the healthcare process. With them, the treatment and specific circumstances can be reported accurately, preventing claim delays and denials. 

  • Is it possible to use multiple modifiers for a single service?

Yes, it is possible to use multiple modifiers for a single service, depending on the specific circumstances or requirements of the treatment.

There can be reasons and circumstances where you can use a single modifier for multiple services. However, they will depend on the specific situations of the procedure and treatment.

  • How important is accurate documentation for Chiropractic Medical Billing?

Claim submission is a time-consuming and complex process that needs training and thorough knowledge of coding. For chiropractic medical billing or any other practice medical billing, an inaccurate process of reimbursement can easily risk the claim submission process. For this, every billing pattern and document should be accurate.

  • Can their specific modifiers be used for Medicare Billing?

Medicare wants chiropractors and medical practitioners to get familiar with the modifiers in order to make sure they get a complete reimbursement.

  • How can proper Reimbursement for Chiropractic Services be ensured?

In order to ensure accurate and complete reimbursement, medical providers like chiropractors will need to stay abreast according to the guidelines, document every detail of the provided services, and use the exact codes assigned to the services provided.

Conclusion

Understanding the top 5 CPT codes and modifiers for chiropractic medical billing is essential for accurate reimbursement and compliant billing practices. Chiropractors can ensure proper documentation, prevent claim denials or delays, and optimize their billing procedures by utilizing the appropriate codes and modifiers. Remember to stay informed about the latest coding guidelines and consult with industry experts when needed to stay ahead in the ever-evolving landscape of chiropractic medical billing.