Author Topic: Chiropractor Sends Notes/Instructions after Seminar  (Read 2929 times)

dfranklin

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Chiropractor Sends Notes/Instructions after Seminar
« on: January 18, 2010, 12:20:47 PM »
Can anyone validate this?  My notes/questions are in blue next to what my provider is saying.

My chiropractor went to a seminar and sent me the following:

Common mistakes and reasons why medicare will not pay for a treatment.

1. No NPI, beneficiary number etc (YES THIS IS OBVIOUS)
2. Box number 11 - insured policy's number or FECA number (YES THIS IS OBVIOUS)
3. incomplete physical exam-documented in block 19 (IS THIS TRUE?  EVERY CLAIM WE HAVE TO GO TO NOTES, FIND THIS DATE AND ENTER IN BLOCK 19?)
4. Missing initial treatment plan date box 14 (IS THIS TRUE?)
5. box 32 and 33 put same address in both.
6. AT Modifier
7. correct diagnosis in box 21 - medicare 739...etc (I AM NOT SURE WHERE TO FIND THE CORRECT CODES)


Than he tells me to the following to get paid with medicare for chiropractic.

1. Box 11  NONE  (If there is a secondary we need to put YES then, correct?)
2. Box 14  Date of first treatment for the dx listed (WE HAVE TO PUT THIS TO GET PAID? AND EVERY TIME THE DX IS UPDATED WE HAVE TO CHANGE THE DATE OF FIRST TREATMENT??)
3. Box 19 Date of 1st X-Ray (AGAIN WE HAVE TO CHECK NOTES FOR EACH CLAIM AND TO FIND DATE AND ENTER IN 19)
4. AT Modifier
5. Level of subluxation box 21
6. Valid secondary diagnosis box 21 (WHERE DO WE FIND THIS?)
7. Modifier on the CPT code-AT block 24D
8. NPI number Block 24J,32,33 (I THOUGHT 32 NPI WAS ONLY USED FOR A FACILITY?)

DENIALS PROSPECTIVE OR RETROSPECTIVE
1. lack of documentation 93% office of insepector general
2. No AT modifier
3. Not a valid dx
4. Invalid date of X-ray in respect to the date of initial treatment - date of first treatment (WHAT DOES THIS MEAN?)
5. Not medically necessary

He then says we are probably already doing this but if not call or email about how to implement....

Any insight anyone can give is great. Thanks!

DMK

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #1 on: January 18, 2010, 01:35:23 PM »
I just finished a HUUUUGE response....then I timed out.  I'll try again.

1. Correct
2. If medicare is primary there is no group # so can be empty.
3. Exam date should be DOI in box 14.
4. Box 14 is DOI
5. Yes
6. Absolutely - Medicare only pays for Active Treatment (AT)
7.  THIS ONE IS HUGE!!!  You and your doctor need to print and be familiar with the LCD. (www.cms.hhs.gov/mcd/viewlcd)  These are the ONLY CODES THAT SUPPORT MEDICAL NECESSITY!!!!!
     The 1st DX should be a 739.x code (the major area of complaint)
     The 2nd DX will determine how much care the patient can get for this injury.  Category I codes are for short term care (backache, headache).  Category II is for moderate term care (unspecified disc disorder, sprain/strain, stenosis). Category III is long term care (disc displacement, disc degeneration, post laminectomy syndrome) and there should be an MRI or CT scan report to justify this dx if requested. 

Your doctor should be the one to give you these codes, so it's important that he code correctly for you to get the most visits possible paid.
 
    The 3rd and 4th DX should be the rest of the 739.x codes if you are billing for adjust 3-4 areas.  (There must be 3-4 dx's to get paid for a 3-4 areas.


Then he tells you.......

1. If primary is M/C it should be empty.  If it's an Advantage plan then there may be a group #.
2. Yes, every time there's a new dx, there should be a new date of injury.  You'll get more visits that way.  If a patient comes in in January and is better after 2 visits, then comes back in April there SHOULD be a new DOI.
3. Box 19 is where I put the levels the doctor worked on (C1-3, T3, L5, SI etc.)  X-ray is no longer required.
4. AT YES
5. Box 21 is your 739.x codes  739.1 Cervical, 739.2 Thoracic, 739.3 Lumbar, 739.4 Sacrum.
6. LCD
7. AT yes ACTIVE TREATMENT
8. The NPI should be attached to the facility #32 Joe's Chiropractic, and the doctor #33 Joe Smith, D.C.

Denials

4.If you're using x-ray to justify your dx, you don't have to anymore!

dfranklin

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #2 on: January 18, 2010, 02:03:33 PM »
Thank you so much DMK!  This is great! It helps me a ton...

Thanks again!!!

dfranklin

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #3 on: January 18, 2010, 03:40:08 PM »
HI DMK,

I am going over how my provider sends us his codes.  He typically sends a patient information sheet once and then anytime the ICD codes are updated.  The ICD codes are just listed on his patient information sheet (with a date they became active).  So We have been taking the 1st 4 codes (with the most recent date) and using those.  So am I safe to say that it is his responsibility to make sure those codes are in the correct order etc as you mentioned in regards to the LCD? 

Also what do I do when he sends us a superbill (only has CPT codes) and sometimes next to 98943-51 he writes use 739.6 or 739.7 or sometimes both for this visit only.  Where would I put that ICD, in # 4?  Those 2 ICD's are not part of the LCD you were referring to when you mentioned 739.x correct?  Plus 98943 is not paid by Medicare anyway but is paid by other carriers I imagine we should still put them on the claim appropriately. Any suggestions?

Thanks again as this is a huge help!

DMK

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #4 on: January 18, 2010, 03:55:12 PM »
It is absolutely his responsibility to make sure to put the dx's in the right order, at least the major complaint area (1st) and the complicating factor (Cat I,II, or III dx). 

Example: Patient comes in with a cervical complaint (739.1), it's a sprain/strain (847.0) but the doctor also treats his mid back (739.2) and oh by the way my wrist is sprained too (842.00).  The CPT should be 98940-AT (1-2 areas), 98943-GAAT (I think that means, not covered and we told him so on the ABN)

Also if it's a new injury, you need to know the levels (C1-3, T8 etc) to put in box 19.  This DOI and DX should be effective until the patient is released, or until the next injury or complaint.  If 2 weeks later the same patient comes in and his low back hurts, you put in a new DOI and DX starting with 739.3 and the complicating factor, and new levels for box 19. 

It seems like a pain, but when they audit you (and all California chiros were audited last July) your treatment notes must match the DOI, DX, and levels or they will deny it.

If you are not a coder for this doctor, he (or she or their staff) should make sure the codes are right before you get the fee slip!

dfranklin

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #5 on: January 18, 2010, 04:45:45 PM »
Man...how did you learn all of this?  Where can I go to learn this stuff? It seems like it is all trial and error and On the Job Training.  I can't find anywhere to teach you this kind of details.

WHich is why i really appreciate your help.

When you put the levels (C1-3, T8 etc) in 19 and the DOI in 14 do you have to keep putting them on each claim until released or new injury? Or does it stay on record with them (carrier/medicare) after you report it initially?


I guess I have to have them send chart notes so I know what the levels are becuase there is nowhere on the superbill for this.

Thanks!

DMK

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #6 on: January 18, 2010, 05:31:45 PM »
All I know is Chiropractic billing.  I went to several HJ Ross seminars, but learned that they don't have ALL the answers.  Some was trial and error.  When Medicare changed from NHIC to Palmetto for processing I spent MANY hours on the CMS site trying to find answers to my questions.  Luckily I only do my office's billing, so I am definitely no expert.  This site has been a great help to me, and I'm glad to pass along anything I may have learned to the next person to make their lives easier!

I, personally leave the DOI (box 14) and the levels (line 19) the same until the patient has a new complaint.  If you are able to see when that patient was last treated, you can see when there is a gap in care and see when they might need a new DOI or DX.  Bear in mind, this is Medicare, the patient's are elderly, they can come for 2 visits for one thing, then have a fall and have a whole new problem. 

It's really important that the Dr. give you the best information so that he gets paid at the right level, and if he ever gets audited, that the claim reflects the correct information with the notes.  Also, if you ever get an audit, make sure the notes are transcribed and SIGNED "reviewed by Dr. Soandso."

Many DC's in our area were only billing a 1-2 (98940) because they could never get a 3-4 paid.  You have to have the dx's to match what you're billing for. 

Also, if your Dr. treats Work Comp patients, if it's a one area injury, you can't bill a 3-4!  Even if he adjusts 3-4 areas.  (Activator docs try to do the 5 area code, it won't fly if your dx is for Cervical only!)

I'm glad I could help.  I hope it's good karma!


Michele

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #7 on: January 19, 2010, 07:44:46 AM »
I only have one comment/question.  When we submit Medicare claims, whether electronic or on paper, and whether Medicare is prime or secondary, if we don't have the word "none" in the group number (box 11) the claim is denied.  Haven't you had that problem DMK?

Michele
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DMK

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #8 on: January 19, 2010, 01:07:30 PM »
No.  I've never put the word "none" on a claim.  Man, your Medicare processor is tough!

I finally HAD to file and get paid by Medicare electronically.  I thought it would be a nightmare, but it's very timely.  You can count the days on the calendar, then check the clearing house for the EOB, and "poof" it's in the bank.  The set up was a NIGHTMARE though.  I still have bad dreams about form 855!

Michele

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #9 on: January 19, 2010, 07:52:58 PM »
We have to put none on all Medicare claims, not just my area.  We've done NY, FL, CA, PA, etc.  That's weird! 

Michele
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Pay_My_Claims

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #10 on: January 19, 2010, 09:23:56 PM »
Michelle, I had to remove it on medicare claims as well here.

Michele

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #11 on: January 20, 2010, 07:10:40 AM »
You mean you used to use it, but now you don't?

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dfranklin

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #12 on: February 17, 2010, 11:50:26 AM »
I am confused when it comes to reporting the DOI, First Treatment Date....

This is for a chiro.  The DOI (Date of Injury) is related to the current DX codes is that correct? So if the Dr updates or provides new DX codes then the DOI gets updated to the date of the new DX codes?

Also do the levels only change when the DX changes (I shouldn't see these change unless the Dr provides new DX codes, correc)?


What about date of first treatment or First Consult?  Does this matter or get reported to the carrier? I don't know what line this would go on, but my software asks for it and also I saw it requested in my software by Medicare.  My software support said that it may not be on the form but it could get transmitted electronically to them.  So is the First TX or Consult date going to be the same as the DOI and reflect the first date the DX codes were reported OR is it the first date EVER that this patient has been seen by the doctor?

Trying to get a good understanding of all these dates etc.

Thanks again for your help!

DMK

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #13 on: February 17, 2010, 04:10:25 PM »
This is Medicare right?

I can only relate what has worked for me.  When the patient presents with something new, or hasn't been in for awhile then all your dates should be updated to the current DOI.  The diagnosis codes could be the same if it's just a flare up of the thing that usually bothers them, but the dates should be updated because it's basically like a new injury.  The vertebra levels the doctor treated on this new DOI should be in box 19.  (They could be relatively the same as most people tend to hurt in the same areas, since they tend to do the same things in their lives).

This will begin, basically, a new treatment plan. So the number of visits allowed (by Medicare for a certain condition) will start over.

For other kinds of insurance the vertebra levels don't need to be reported.  But your DOI and current diagnosis should reflect each plan of treatment as most insurance companies DON'T pay for supportive care.  Any time there's a change in the patient's condition or a significant event that has triggered this new need for care (fall, trip, slept wrong, dog pulled them) there should be a new DOI.  This helps avoid red flags from the insurance company.

EVEN IF the patient is one who gets fairly regular care, keep an eye on the DOI and the dates of service so everything is current.  Chiros in particular get kind of set in what they're doing and don't always update their DX's and DOI's.  If a file looks stale, you might want to ask the doc.

Dina

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Re: Chiropractor Sends Notes/Instructions after Seminar
« Reply #14 on: March 08, 2010, 02:54:17 PM »
I only have one comment/question.  When we submit Medicare claims, whether electronic or on paper, and whether Medicare is prime or secondary, if we don't have the word "none" in the group number (box 11) the claim is denied.  Haven't you had that problem DMK?

Michele


Michele, I bill for MI - same here - without "none" the claim is rejected.