Coding and billing for instrument adjusting

These are confusing times for DCs and office staff members who must code and bill for services.

Many offices are transitioning to electronic health records (EHR) systems, which means new procedures are being learned and implemented. At the same time, the Office of the Inspector General at the federal level, as well as many other regulation-enforcing organizations at the state level, is increasing its scrutiny of payments made to chiropractors.

Added to that, it seems insurance companies find new reasons to reject claims almost daily. And, on October 1, the 10th revision of the International Classification of Diseases (ICD10) will take effect.

Making an investment in any new tool or device that will help your patients and allow you to add a service is usually a good idea. However, if you do not understand how to code and bill for services rendered with that device or tool, you may find yourself stuck in a collections quagmire. Instrument adjusting tools are beneficial to the DCs who use them and to the patients who receive adjustments — particularly patients who are frail, afraid, under a great deal of stress, or in excruciating pain.

There has been some confusion, though, on how to code and bill for those adjustments, especially when the claim is being submitted to Medicare.

Some of the confusion is attributable to what, exactly, defines a “manual adjustment.” Most people who work in chiropractic care probably think of manual adjustments as those delivered by hand, without the use of instruments. However, the Centers for Medicare and Medicaid Services (CMS) defines “manual adjustment” a bit differently (emphasis added): “Coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation provided such treatment is legal in the State where performed. In addition, in performing manual manipulation of the spine, some chiropractors use manual devices that are handheld with the thrust of the force of the device being controlled manually. While such manual manipulation may be covered, there is no separate payment permitted for use of this device.”

According to the CMS, handheld instruments that are controlled manually, rather than electronically, fall into the category of “manual adjustments.” There are other rules regarding what types of chiropractic care Medicare will pay for, of course. For instance, maintenance adjustments are not covered.

One of the most important steps DCs can take is to make sure that there are clear notes for each patient and each visit. In the case of a claim being denied or audited, those notes can be particularly important. A thorough review of office procedures, along with a carefully constructed plan to transition to ICD10, is a good measure to take to make sure claims are paid.