Many chiropractic offices have lists of frequently-used codes to refer back to.
Some chiropractors report specific codes being reimbursed more consistently than other codes, depending on the insurance carrier. Some codes may also be more difficult to obtain reimbursement for.
Looking carefully at how your office codes can help streamline coding practices, while also highlighting potential problems.
Common codes in chiropractic care
Not surprisingly, codes related to spinal manipulation and therapies are very commonly used in chiropractic offices. Clinics that specialize in specific areas of chiropractic care may code for particular procedures more often.
Scott Schreiber, DC, of Delaware Back Pain and Sports Rehabilitation Center, says he uses a lot of manipulation, physical examination, and therapy codes. Because he is also a licensed nutritionist and acupuncturist, he uses codes in these disciplines as well.
“I see more spinal cases, but I also see a lot of shoulder and knee issues,” Schreiber says. “I also see many patients that have headaches, nerve conditions and repetitive use injuries.”
Schreiber’s most frequently-used chiropractic codes include:
- Manipulation: 98940-98943
- Evaluation and Management, Initial Visit: 99202-99204
- Evaluation and Management, Established Patient: 99212-99214
- Therapeutic Exercises: 97110
- Neuromuscular Re-education: 97112
- Manual Therapy: 97140
- Physical Performance Examination: 97750
Richard Yost, DC, of Norwood Chiropractic & Sports Injury Center, uses these codes the most in his practice:
- Therapeutic Exercises: 97110
- Manipulation: 98940 and 98941
- Manual Therapy: 97140
Brian Zelasko, DC, of Zelasko Soft Tissue & Spine says these are his most common codes:
- Initial Exam: 99203
- CMT 1-2 Regions: 98940
- Manual Therapy: 97140
- Therapeutic Exercise: 97110
- Reevaluation: 99211
By making your own list of frequently-used codes, you may begin to discover patterns in the types of conditions you see or in the therapeutic needs your patients have. From there, you can learn how to quickly use these codes, while also providing enough documentation. Your “cheat sheet” can provide a shortcut to use while coding, as long as you remember to customize and review your entries.
Reimbursement consistency
Some clinics encounter issues when billing for particular codes with particular insurances.
“We have had reports that insurance companies are denying our patients the code 97110 [Therapeutic Exercise] because it’s supposedly only for Physical Therapy,” says Zelasko.
Zelasko believes these issues began after Affordable Care Act (ACA) changes were implemented. The use of this code, he says, is not limited to physical therapy but is treated differently by some companies.
“We know this isn’t true because we bill and get paid for that code on no-fault, personal injury cases from insurance companies on a regular basis, and they are paid the same by every insurance company,” he says.
Schreiber said he usually receives consistent payment for manipulation, evaluation and management codes but receives smaller reimbursements for the heat and ice therapy code, 97010. Accident claims, such as worker’s compensation and motor vehicle accident injury claims are somewhat easier to obtain reimbursement for.
Yost says that most codes his office uses are reimbursed consistently, but he notes that contractual issues can cause his codes to be denied.
Codes that are more commonly used by chiropractors may present fewer issues during the reimbursement process, but understanding code best practices may also help reduce claim rejections and boost reimbursements.
Making your own list
While creating your coding “cheat sheet,” you may want to also create a list of codes that cause the most trouble for your office.
By looking for problem codes, you may identify areas where additional coding training is needed or additional documentation is necessary.
