Experts answered your questions from Chiropractic Economics’ Nov. 4 Webinar titled “Billing & Coding: Let’s get it right, OK?” Please check the Web site frequently for answers to upcoming Webinars.
Q. Review what patient information is required for E&M coding — Pt outcome assessment questionnaires to us. Is the Soap the best way to demonstrate care is affecting pt outcome. Are there outside monitors who can audit your document to assure quality control?
A. E/M coding requires three key components: history, examination, and medical decision making. E/M coding is a very comprehensive topic. I recommend you consider purchasing Target Coding’s book on E/M coding, compliance, and documentation. Re-examination is also part of E/M coding and is the best ways to demonstrate patient outcome. Also, if you are in-network, check with the plan requirements. (Marty Kotlar, DC, CHCC, CBCS)
Q. I’m having a lot of problem with 97032 and 97010 being bundled into the manipulation code.
A. Send the carrier an appeal letter requesting how they came up with their decision — if you would like a copy of this appeal letter contact Target Coding at 800-270-7044. Also, if you are in-network, check with the plan fee schedule. (Marty Kotlar, DC, CHCC, CBCS)
Q. Notes for precert, what determines approval?
A. Yes, your SOAP notes and evaluations determine approval unless you are in-network. (Marty Kotlar, DC, CHCC, CBCS)
Q. Clarification sought on therapeutic activities, neuromuscular re-education; is this a timed code? E&M codes — are they timed or do they have certain criteria that need to be fulfilled to qualify for the different levels?
A. Yes, those two services are time-based. E/M codes do have “approximate” times; however, time is considered a contributing factor not a key factor. Also, if you are in-network, check with the plan requirements on time-based codes. (Marty Kotlar, DC, CHCC, CBCS)
Q. What risk does patterning care pose where most patients are treated in what appears to carriers as a rubber-stamped routine schedule (regardless of diagnosis) neglecting the individuality of the wide variety of differences in individual cases?
A. I call this “cookie-cutter” chiropractic. This type of care causes a very big “red-flag” — please stay away from this. (Marty Kotlar, DC, CHCC, CBCS)
Q. I am most interested in knowing if there are reasons to change diagnosis throughout ones care; and how one proves that those changes are appropriate to the original cause.
A. Update the diagnosis as the patient’s clinical presentation changes. (Marty Kotlar, DC, CHCC, CBCS)
Q. How do you code for an adjustment that is not a specific thrust technique (for example blocking, Activator, BioCranial)?
A. You can code Activator as 98940, 98941 or 98942. A cranial adjustment can be billed with 98943. (Marty Kotlar, DC, CHCC, CBCS)
Q. Any clues about additional information one can give if one is audited by Medicare to get that payment back for insufficient info for medical necessity?
A. Your documentation is the key. Medicare has specific requirements. I recommend you consider purchasing Target Coding’s book on Medicare coding, documentation, and billing. (Marty Kotlar, DC, CHCC, CBCS)
Q. What is the appropriate diagnosis for cervical traction (decompression)?
A. Here are the 8 best:
721.0: Cervical spondylosis without myelopathy
722.0: Displacement of cervical intervertebral disc without myelopathy
722.4: Degeneration of cervical intervertebral disc
722.91: Cervical intervertebral disc cartilage calcification
723.1: Cervicalgia (neck pain)
723.5: Torticollis, unspecified
723.8: Other syndromes affecting cervical region
847.0: Cervical sprain and strain/Whiplash injury (Marty Kotlar, DC, CHCC, CBCS)
Q. Is there a good book on verbiage to use for goals outcomes etc.?
A. Yes, I recommend Steve Yeoman’s, DC book — check out www.yeomansdc.com. (Marty Kotlar, DC, CHCC, CBCS)
Q. How does one truly know that for any given condition how many visits insurance company will pay for that condition so to avoid post-payment audits? In PA there is no cap on the time an insurance company can go back in a post-payment audit.
A. You cannot — so I recommend that you provide the care that is necessary to get the patient better and don’t worry about being audited. Just remember, that when you feel that the patient has reached maximum improvement, transfer them to maintenance and self-pay. (Marty Kotlar, DC, CHCC, CBCS)
Q. I need the new codes for billing for 2009?
A. There have not been any changes to the chiropractic codes for 2009. (Marty Kotlar, DC, CHCC, CBCS)
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