Medical Billing Forum

Billing => Facility Billing => Topic started by: mauletta on March 30, 2010, 05:56:09 PM

Title: Chiropractic coding
Post by: mauletta on March 30, 2010, 05:56:09 PM
What diagmosis codes should be used for cpt 98941 when CMT is performed on the cervical, thoracic and sacrum regions?
Title: Re: Chiropractic coding
Post by: Pay_My_Claims on March 30, 2010, 06:22:32 PM
what dx did the md give? You can't "find" a dx to justify billing, you bill the procedure according to the dx that he gave. A good biller will let his MD know that if this is what he is coding, then the ins may deny unless the patient actually has another issue.
Title: Re: Chiropractic coding
Post by: Michele on March 30, 2010, 08:15:02 PM
The diagnosis must come from the dr, like Charlene said.  But if you are billing Medicare you can make the dr aware that Medicare requires that the primary diagnosis must be a 739.x dx, and the secondary dx must be on the list of Medicare acceptable dx's.  You can't pick the dx's for them, and they can't pick dx's just to get the claim paid.  But you should make them aware so they can code appropriately for the patient.

For Chiros it's a little unusual because Medicare specifies what diagnoses they accept.

Michele
Title: Re: Chiropractic coding
Post by: mauletta on March 31, 2010, 09:37:06 AM
The problem is the dr. isn't sure what code to use for the diagnosis. Subluxation of the cervical, thoracic and sacrum region
Title: Re: Chiropractic coding
Post by: DMK on March 31, 2010, 10:43:34 AM
The subluxation (dislocation) codes (839.x) no longer work.  You must use the Segmental Dysfunction codes (739.x).  Michele is exactly right.  The 1st dx must be the 739.x (whatever area the patient's MAJOR complaint was, cervical, thoracic, lumbar), the 2nd code is the complicating factor and you can only use the ACCEPTED codes that Medicare uses. The 3rd dx should be the next area of complaint (739.x) and the 4th dx should be the next area of complaint (739.x). 

Now you have 3 areas so you can bill a 98941.  Be sure the doctor is aware that the 2nd diagnosis (the complicating factor) will determine how much treatment is medically necessary. 

Dina
Title: Re: Chiropractic coding
Post by: mauletta on March 31, 2010, 01:21:25 PM
Thank you so much Dina I really appreciate your help!

Maria
Title: Re: Chiropractic coding
Post by: Pay_My_Claims on March 31, 2010, 06:22:28 PM
The problem is the dr. isn't sure what code to use for the diagnosis. Subluxation of the cervical, thoracic and sacrum region

dr needs to go back to school
Title: Re: Chiropractic coding
Post by: Alice Scott on April 01, 2010, 05:45:45 AM
I love you Charlene!
Title: Re: Chiropractic coding
Post by: DMK on April 01, 2010, 10:48:19 AM
It is unfortunate that the doctor doesn't know which diagnosis code to use.  The doctor SHOULD be able to use a correct code easily.  But there's a bit of a "conspiracy" with the insurance companies, Medicare in particular.  In some states they will pay the 739.X Segmental Dysfunction Codes, sometimes pay the 839.X Subluxation codes. In California, Medicare used Subluxation codes until 2009 then switched to segmental dysfunction codes.  Both are good codes, describing a segment of the spine that is not moving properly.  It's not apples and oranges, it's Red Delicious and Fuji!

In chiropractic there's a "school of thought" called a Subluxation based practice.  It's where the philosophy is that "subluxations" cause all disease and ill health.  If the doctor corrects the subluxation, he "cures" the disease.  The problem is, the medical definition of subluxation is dislocation.  The spinal bones may be out of alignment but they're rarely medically dislocated. But if your doctor is a subluxation based practice, he may always want to bill 839.X codes.  And he might not get paid.

It's a tough one, unfortunately we sometimes have to figure out how the insurance company WANTS it coded in order to get paid for our services.  Screwy huh?  We've fought for years to be treated like other specialists, but since there are still so many wacky chiropractors out there it's an uphill battle.

Your Chiro may want to go to a billing seminar so that he understand how to code correctly so that his biller can get his claims processed correctly and quickly.  Since you're a biller, not a coder, it makes it tough for you to process his "garbage" and turn it into cash!

Dina
Title: Re: Chiropractic coding
Post by: Pay_My_Claims on April 01, 2010, 10:56:29 AM
I love you Charlene!

(( hug ))
Title: Re: Chiropractic coding
Post by: mauletta on April 02, 2010, 02:40:20 PM
Thank you so much Dina.......I really appreciate your help!  You have cleared up alot of things for the Dr.,  I don't want to be too harsh with her since she is my niece!  I'm just trying to help her out with her new practice. Thanks again! 
Title: Re: Chiropractic coding
Post by: PMRNC on April 03, 2010, 01:20:59 PM
Quote
It's a tough one, unfortunately we sometimes have to figure out how the insurance company WANTS it coded in order to get paid for our services.  Screwy huh?  We've fought for years to be treated like other specialists, but since there are still so many wacky chiropractors out there it's an uphill battle.

Throw away this line of thinking!  Insurance companies cannot and should NOT be telling you how to code at all.
Title: Re: Chiropractic coding
Post by: oneround on April 05, 2010, 02:38:58 AM
LOL, Ditto to Charlene. i do have a question, I've coded for a long time and never once have I met a MD, chiro, etc. that can code. I mean they can dictate, but am I late on the school bus?  You find me an MD that has time to code, dictate and see patients and I'll find u and auditor that says, 'You need practice management'.  Just my opinion.
Title: Re: Chiropractic coding
Post by: PMRNC on April 05, 2010, 07:24:10 AM
I agree it is difficult, but I always refer back to the FACT that regardless of who in the office is coding or can code.. ULTIMATE LEGAL responsibility is with the doctor. They are in the room with the patient.  I've been pretty lucky, the ones I deal with (past and present) are pretty good with coding, only one of my offices has an on-staff coder who is not CPC but is just as qualified and really good at what she does. I think it really depends on how you sell yourself and set yourself up in the beginning.. I am pretty clear up front and in my contract that coding is their ultimate responsibility. If I do find an error it goes back to the doctor/provider and they are responsible for correcting and signing off on any change.
Title: Re: Chiropractic coding
Post by: Pay_My_Claims on April 05, 2010, 05:24:05 PM
LOL, Ditto to Charlene. i do have a question, I've coded for a long time and never once have I met a MD, chiro, etc. that can code. I mean they can dictate, but am I late on the school bus?  You find me an MD that has time to code, dictate and see patients and I'll find u and auditor that says, 'You need practice management'.  Just my opinion.


Lucky me, I have worked for several who can...(greedy MD's can code their butts off!!)
Title: Re: Chiropractic coding
Post by: DMK on April 05, 2010, 05:58:47 PM
Unfortunately, greedy chiros do code their butts off!  And some of it's not good coding.  I'd love to "throw away" my trials and tribulations with the insurance companies, but I get different stories from different claims processors.  They ultimately hold the purse strings and I HATE it when they change the rules midstream.  I am completely willing to play by the rules (sometimes to a fault) but don't change the rules in the middle of the game!  I'm not 7 years old.....wait a minute, what day is this?  Maybe I am 7 today, I'm sure whining like I am!  ;D
Title: Re: Chiropractic coding
Post by: Pay_My_Claims on April 05, 2010, 07:23:54 PM
Unfortunately, greedy chiros do code their butts off!  And some of it's not good coding.  I'd love to "throw away" my trials and tribulations with the insurance companies, but I get different stories from different claims processors.  They ultimately hold the purse strings and I HATE it when they change the rules midstream.  I am completely willing to play by the rules (sometimes to a fault) but don't change the rules in the middle of the game!  I'm not 7 years old.....wait a minute, what day is this?  Maybe I am 7 today, I'm sure whining like I am!  ;D

well we know Insurance companies don't play by the rules..LOL j/k