Author Topic: Diagnosis Ordering (Chiro)  (Read 2434 times)

Csinsay

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Diagnosis Ordering (Chiro)
« on: September 29, 2010, 11:33:47 AM »
Hi,

Can someone please explain Dx Ordering.  I have been hearing different things. 

For Chiropractic Specialty, this is what I typically follow:
1. Neurological and Pain Syndromes
2. Subluxation
3. Structural and Functional Disorders
4. Unspecified Conditions, Muscular Conditions and Congential Anomalies

Thanks!

DMK

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Re: Diagnosis Ordering (Chiro)
« Reply #1 on: September 29, 2010, 05:17:44 PM »
It depends on who you're billing.

Medicare is VERY specific.

Use 739.X for the first dx, for the area of major complaint.   .1 for Cervical, .2 for Thoracic, .3 for Lumbar.
They do not accept subluxation codes anymore. 

The 2nd dx is the complicating factor.  The CMS web site has a printable list of the ONLY acceptable conditions for medical necessity.

The 3rd dx is 739.X if there is an additional area being worked on.

The 4th dx is 739.x if there is another area being worked on.


All other insurance should use 739.x codes 1st to show a 1-2 area or 3-4 area, or extremity being adjusted.  Then the complicating factors. Sprain/strain, headache, muscle spasm etc.  The insurance companies want to see the areas being worked on to verify the procedures being performed, then the complicating factors.




Csinsay

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Re: Diagnosis Ordering (Chiro)
« Reply #2 on: September 29, 2010, 07:18:10 PM »
Thank you DMK.  How about for commercial insurance carriers like Blue Cross, Cigna, etc?

Michele

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Re: Diagnosis Ordering (Chiro)
« Reply #3 on: September 30, 2010, 03:22:18 PM »
I have found with commercial insurances they do not require any specific ordering of diagnosis for chiropractors.

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DMK

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Re: Diagnosis Ordering (Chiro)
« Reply #4 on: October 01, 2010, 10:21:34 AM »
Correct, they don't require specific ordering, but bear in mind that you have to have diagnosis to match what procedures you're billing for.

If you are billing for adjusting 3-4 areas, you can't show 724.2 (lumbago), 739.3 (Lumbar Intersegmental Dysfunction), 847.2 (Lumbar Sprain/strain), and 724.4 (Leg Radiculitis) and expect to get paid for a 3-4.  Those are all diagnosis for 1 area.  You need to show all the regions be worked on.  If you're billing a 3-4 and an extremity adjustment then the 4 dx's that will show up on the HCFA should be for the 3 regions and the extremity being worked on. Does that make sense?

It's most important (at least in Chiropractic billing) to show the AREAS being worked on, then the complicating factors.  With other medical providers, I'm sure, it's totally different.

Michele

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Re: Diagnosis Ordering (Chiro)
« Reply #5 on: October 01, 2010, 11:55:48 AM »
Yes, very good point.  Your dx's must support the services being rendered!

Michele
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Christy

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Re: Diagnosis Ordering (Chiro)
« Reply #6 on: June 03, 2013, 03:46:18 PM »
can anyone help me figure out why these medicare chiro claims were denied for non cov dx?  all were billed 98940- AT,

1) 739.3    724.2   724.3

2) 739.3   724.3    739.1

3) 739.3   724.3    739.1   723.1

4) 739.3     724.3     722.52    739.1

thanks!

DMK

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Re: Diagnosis Ordering (Chiro)
« Reply #7 on: June 03, 2013, 05:20:20 PM »
It must be a LCD problem with the 2nd dx of lumbago and sciatica.  EXCEPT your 4th example.  The 722.52 should be your 2nd dx (you'll get a longer treatment plan) before the 739.1.  Be sure to check the LCD's for your specific Medicare processor.

You may want the doctor to be more specific with his/her complicating factor.  Sprain/strain or radiculopathy are usually more correct than lumbago or sciatica.

There was a time in the not too distant past where the Primary ICD-9 code was an 839.XX code.  So, again, verify YOUR particular LCD.

Christy

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Re: Diagnosis Ordering (Chiro)
« Reply #8 on: June 03, 2013, 07:41:13 PM »
thanks sooooo much, DMK! ;D