Insurance billing and coding changes occur all the time. This year alone, 600 CPT codes and 1,100 diagnosis codes have been changed or updated.
Times have changed. Years ago, chiropractors didn’t have to worry so much about billing and coding errors. It just wasn’t a priority. Nowadays, billing and coding errors are not only being closely monitored; they may be severely disciplined.
The federal government has made it a high priority to punish people who commit health-care fraud. The Office of Inspector General (OIG) has made the chiropractic “maintenance” treatment of Medicare patients one of its biggest priorities.
You need to be very careful how you bill patients. You may be committing a violation and not even know it. Ignorance of the law does not exempt you from being disciplined, fined and possibly having your license revoked.
One of the biggest procedure code (CPT) changes to affect chiropractors and physical therapists occurred last year. These modifications dramatically affect the way you are required to treat patients with regard to “timed” procedures (i.e., 97140, 97035 and 97110). The Health Care Finance Administration (HCFA) has redefined how to calculate the 15-minute timed procedure codes (97032-97036, 97110-97124, 97140, 97504-97542 and 97703-97770).
Section AB-00-14 of the HCFA regulations states that providers should bill for a single unit if services are equal to or greater than eight minutes but less than 23 minutes. Providers should not bill for services performed for less than eight minutes. Two units are defined as services equal to or greater than 23 minutes, but less than 38 minutes; three units: equal to or greater than 38 minutes, but less than 53 minutes; four units: equal to or greater than 53 minutes, but less than 68 minutes; five units: equal to or greater than 68 minutes, but less than 83 minutes.
For example, if a patient receives five minutes of ultrasound (97035), six minutes of manual therapy techniques (97140) and 10 minutes of therapeutic exercises (97110), the total time is 21 minutes. You would bill one unit of 97110, because it’s the longest. You can no longer include pre- and post-delivery time.
The topic of correct coding combinations seems to generate a lot of interest among chiropractors. What you may not know is that these combinations change every three months.
There are two main types of coding combinations:
- Mutually Exclusive Procedures – These are procedures that cannot be performed during the same session. A few examples of these procedure code combinations are shown on this page. They are divided into Column 1 and Column 2 procedures. The Column 2 procedure will not be reimbursed when it is rendered by the same provider on the same date of service, since it cannot be performed during the same operative session as the Column 1 procedure.
- Comprehensive and Compound Procedures – A few examples of these procedure code combinations are shown on the next page. They are divided into comprehensive code (first column) and component code (second column) procedures. The component procedure will not be reimbursed when it is rendered by the same provider on the same date of service, since it is a part of the comprehensive procedure.
In today’s managed-care environment, you must stay informed about the latest billing and coding changes. Hire a professional, train a qualified staff member, or do it yourself… but please do it.