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Chiro Modifiers and Dx Pointers

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cardinal:
Hello

I am new to the forum and Chiro Billing.  I have billed dermatolgy and now have a Chiro client.  I am not clear on the use of modifiers and DX pointers for optimal reimbursement.  Here is a superbill scenario:  CPT's 98941, 97140, 97110, 97035, 97010, 97012, 97032.  Dx's 739.1, 739.2, 739.3, 739.5, 723.1, 728.85, 719.46.

My understanding is that I only use the 59 modifier when billing other procedures i.e. 97140, 97124, 97110) with the CMT codes (98940, 41, 42 etc).  Is this correct or do I need the -59 when billing the other CPTs? 

If the doctor performs the modalities or therapy procedures on each complaint area is it okay to point all dx codes to each CPT?  OR, do I need to point the Dx's differently?

HELP!  I expect this is pretty straight forward for experienced chiro billers, my head however is spinning!  I hope my question is not too lengthy or confusing.  Any input with regard to chiro billing using modifiers and dx pointers is appreciated.

Thanks
Nancy :)

Michele:
Nancy,

Yes you use the 59 modifier on the modalities when billing the CMT codes.  You need to point the diagnosis that the procedure is primarily being done for to the service code (which the dr would have to tell you).  However, some insurances like Medicare require certain diagnosis be in certain positions.  For example, they require that a 739. code be in the primary position and a valid 2ndary diagnosis be in the 2nd position.  So in your example you might have:

1.  739.1
2.  723.1
3.  739.2
4.  739.3
5.  739.5
6.  728.85
7.  719.46

Hope that helps.

Michele

cardinal:
Good morning Michelle,

Thank you for your reply, it was very helpful.  More questions regarding -59 modifier.  If I am billing 97110, 97124 with the CMT's do I use the -59 on both?  Also, if I am billing them without the CMT's do you recommend modifiers?  Given research I have done on the internet I am confused as to the correct/best way to use this modifier to be sure I am getting proper reimbursement for my client.  Is there a resource that you would recommend that would give actual CMS-1500 claim examples with regard to billing for chiro?

Yesterday I purchased your e-book on Chiropractic billing, it has been very helpful.  Do you have any input or knowledge of The Chirocode Deskbook?  I am looking for additional information for chiro billing so that my knowledge base continues to grow.

Thanks again
Nancy

Michele:
Glad you found the book helpful.  I do not have any knowledge of the Chirocode Deskbook.  Sorry.  As far as the 59 modifier, it should go on any service other than the main service provided, if that service is completely independent from the main service.

Michele

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