Author Topic: Medicare Chiropractic Billing  (Read 927 times)

kmoore

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Medicare Chiropractic Billing
« on: February 18, 2009, 08:38:51 PM »
Hello Michelle,
Haven't posted in a while but had a question, have our first Medicare patient and have been reading your posts and wanted to make sure I submit these claims correctly.
I have dx codes of 739.1, 739.2, 721.0 & 781.92 using cpt codes 99202-25, 98940-AT, 97012-GP & S9090
Is this correct on the codes and modifiers?
Thanks for the help, also is there a medicare manual or something that I can get ahold of with answers to the codes they accept and modifiers to use?
Thanks
Kim

Michele

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Re: Medicare Chiropractic Billing
« Reply #1 on: February 18, 2009, 09:04:56 PM »
The only thing I can see a problem with is the order of the diagnoses.  You must have a 739 code primary, but you can't also have a 739 in the second spot.  I would do the order as:  739.1, 721.0, 739.2, 781.92.


Michele
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catooch

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Re: Medicare Chiropractic Billing
« Reply #2 on: February 20, 2009, 11:54:09 AM »
Micelle,

Why is it you cannot have two 739 codes in a row?

Cathy

Michele

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Re: Medicare Chiropractic Billing
« Reply #3 on: February 21, 2009, 09:50:58 PM »
Medicare requires that you use a 739 primary, but they require one of the diagnoses on there list of approved secondary diagnoses.  They don't allow a 739 code secondary, but you can use them in the 3rd or 4th spot.

Michele
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kmoore

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Re: Medicare Chiropractic Billing
« Reply #4 on: February 23, 2009, 06:17:52 PM »
Michelle,
Is there a way I can get ahold of a list of dx codes that Medicare needs to have used and the order that they need them on the claims?
Thanks
Kim

Michele

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Re: Medicare Chiropractic Billing
« Reply #5 on: February 23, 2009, 07:42:11 PM »
Kim,
   This web page has a list of covered diagnoses:

http://www.squidoo.com/chiropracticcodes

Michele
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Christy

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Re: Medicare Chiropractic Billing
« Reply #6 on: May 14, 2013, 10:01:26 AM »
digging up this old thread :)

I am submitting a bunch of old Medicare claims for a new chiro that has not submitted them in a year.

Many are denied invalid inital treatment date? I used the date of symptom onset for the claims, am I missing something? LIke if the patient first came in 2006, but had a gap and came back in 2012, I would use a 2012 date in box # 14. Is this correct?

thanks!!!! ;D

DMK

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Re: Medicare Chiropractic Billing
« Reply #7 on: May 14, 2013, 10:16:44 AM »
#1 - you only have a year to file Medicare claims.  If the doctor wasn't a participating Medicare provider (you said he was new) he can bill, but they won't pay him since he wasn't participating until they (CMS) said he was validated.

#2 - Use the current year for the injury, never mind the past treatment particularly with that much elapsed time.  Medicare only pay for ACTIVE treatment so be sure to use the AT modifier on the CPT code.  Even if they have had a neck sprain/strain in the past, use CURRENT dates.

#3 - Be sure to put your diagnosis in the correct order, 1. Main area 739.X  2. Complicating factor (sprain/strain, or if the patient's file has an x-ray or MRI indicating DJD or stenosis or herniation then be sure to put in the test date) 3. Then the next area 739.x etc.  The complicating factor in the 2nd diagnosis space will determine how many visit they will pay for for that date of injury.  I can't stress strongly enough, don't just put in a diagnosis in January and let it ride, every time there's been a gap in treatment put in a new diagnosis for what's going on currently!

#4 - Line #19 should show the levels being treated.


Christy

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Re: Medicare Chiropractic Billing
« Reply #8 on: May 14, 2013, 10:21:06 AM »
thanks DMK!

The chiro is new to me, but not a new provider with Medicare....yes, we are submitting claims less than one year old.

For the supporting dx, that is related to how many treatments are approed, is there a way to find out how many treatments each allows?

is there a published list someplace?


thanks so much!

DMK

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Re: Medicare Chiropractic Billing
« Reply #9 on: May 14, 2013, 12:56:51 PM »
There is NO where they show how many visits are allowed.  Patients have the number 20 in their head or they've been told that.  Red flags do come up when there's too much treatment.  Chiro is supposed to be ACTIVE TREATMENT that gets the patient over this injury. (I know, most elderly patients have so much arthritis or damage that they'll never be 100%, but they will have flare ups of the same thing).

The LCD I have shows Category 1 is "short term" treatment (this would be headache, lumbago, pain etc).

Category 2 is "moderate term" treatment (this includes sprain/strain, spondylolisthesis, torticollis, disc disorders)

Category 3 is "long term" treatment (herniated discs, DJJ, DJD, sciatica) if you have a report date of an X-ray or MRI that SHOWS the problem it helps support the diagnosis.  Particularly if you get a request for additional information, ALWAYS send the reports.

I have patients that come 3-4 times per year, and one guy we see regularly.  I haven't had treatment denied, but we're very careful in documentation and making sure the patient understands that Medicare only pays ACTIVE treatment.

Christy

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Re: Medicare Chiropractic Billing
« Reply #10 on: May 14, 2013, 01:18:40 PM »
thanks so much, DMK!