Chiropractic coding with confidence in today’s regulatory climate

Chiropractic coding doesn’t have to be complicated — it comes down to the ABCDEs of coding

Chiropractic online community coding discussions are often like the discussions you hear on a talk show. One person has an opinion on coding based on what a friend is doing. Another just returned from a seminar and fear is the driving factor, while others code the same way they have for the last 15 years.

So how does someone code with confidence?

What is the most effective way to communicate with your payers? Actually, it is simply learning the easiest foreign language in the world — and I’ll bet you didn’t realize that learning a new language could be easy. Let’s look at our new language, “The Coding Language,” from the beginning.

Find and translate

First, understand the subjective reasons your patient has come to your office. Second, consider the objective findings and translate them into your documentation. Third, convert all of this into “The Coding Language” by using CPT and ICD-10 coding to translate to the language your payer requires.

Finally, transmit this new language the appropriate way with the appropriate documentation. In this language course, if you are successful in translation, you will get paid quickly and easily for the services you performed.

It comes down to the ABCDEs of chiropractic coding:

• Accuracy in Coding
• Be Current on Coding Policy
• Consistent and Complete Documentation
• Develop Policies and Procedures
• Evaluate Regularly

Accuracy = translation = understanding = proper reimbursement

Accuracy in chiropractic coding doesn’t have to be complicated but does require some education on the guidelines. Both the doctor and the staff must understand the mechanics of coding to avoid over- or under-coding.

The easiest way to stay accurate is to provide a service — and then find the best code for that service. You can count on a denial when you first find a code you want to bill, and then try to tie that code to the service you performed. When you are coding an evaluation and management (E/M) service, chiropractic manipulative treatment (CMT) or any other code applicable to your practice, make sure the coding matches the documentation. The more accurate you are, the better it “translates” to your payer — and can eliminate dialogue back-and-forth with more questions.

Being current in coding = compliance

Coding changes often — sometimes every year! It is vital that you and your team understand the updated codes. Whether you learn best in a seminar setting, by reading publications or by studying in an online library of training, don’t miss this critical compliance process. The onus is placed on the provider to stay up to date on new coding changes. This includes understanding your payer’s interpretation of chiropractic coding.

For example, there are viable codes for certain services, but that doesn’t mean your payer will consider them for reimbursement. Kinesiology taping is a great example: Most payers consider it experimental, unproven and investigational. Know how to code these instances in order to receive proper payment from your patient.

Consistent and complete documentation

Understanding the language of documentation can be tricky, especially if it’s not applied consistently. Consider that you’ve taken a Spanish course and feel pretty good about conversing in the language. Then you speak with someone who is a native speaker of Spanish. You hear a mix of slang, Puerto Rican Spanish, Castilian Spanish and so forth. It can cause you to second-guess everything you’ve learned, and before you know it, you really don’t comprehend any of it.

This same concept can apply to your practice when there is a lack of consistency in the descriptors of your services. This translation disaster will reflect on your practice. All services rendered in the visit must be included in the treatment plan.

The patient’s response to treatment should be included. All ancillary services should be documented and if time-based codes are used, the documentation must reflect this time.

Develop policies and procedures

Many offices admit that their policies and procedures consist of a verbal, “Remember, we decided on that a few years ago!” Compliance regulations require that policies and procedures are written and easily accessible. They should also be accompanied by regular training in your office.

As a part of your practice’s compliance program, develop clear coding, billing policy and procedure as required and follow it. Do you understand, for example, when you code 97124, therapeutic massage, vs. when you code 97140? Or when you code 97110, therapeutic exercise vs. 97530, therapeutic activities? If not, your chiropractic coding could be deemed willy-nilly. Let clear policy and procedure drive your coding for safety and peace of mind.

Evaluate regularly

Because coding rules change, your coding processes must be evaluated regularly. Not only do the coding rules change, but we change. Think about your documentation today as compared to even a few years ago. It probably looks different, perhaps more robust. Perhaps you offer more services than you did before. We can expect a big coding change in 2020, when dry needling will get a CPT code. Many who provide this service have had to code it “the best they can,” but that will change.

All chiropractic coding and documentation should be constantly updated and evaluated. Consider the Golden Gate Bridge. Just when they think they have it painted and are at the other end, they go back and do it again. Continual and ongoing updating can provide peace of mind. Self-audits, or a proactive audit by an outside company, are always a good idea.

These self-evaluations can enhance confidence in your processes. If you don’t know how to do this, remember, you don’t have to know everything; you just have to know someone who does.

Apply your language skills

Coding is a language that comes with practice, resources, education and ongoing immersion. There are many tools available to assist both doctors and staff to ensure they are coding with confidence. Immerse in this language one item at a time. Gain confidence with E/M coding. Understand all aspects of what makes up a 99203 compared to a 99213.

Next, dive into the inner workings of CMT codes, such as the necessary documentation requirements of spinal CMT vs. extra-spinal CMT, code 98943. Study each category of your office’s services and codes and master each area. If you do, you will be able to code with confidence. Remember how to eat an elephant? One bite at a time.

KATHY MILLS CHANG is a Certified Medical Compliance Specialist (MCS-P), Certified Chiropractic Professional Coder (CCPC), and Certified Clinical Chiropractic Assistant (CCCA). Since 1983, she has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy leads a team of 21 at KMC University and is known as one of our profession’s foremost experts on compliance, Medicare, documentation and CA development.