Billing > Billing
Chiropractor Sends Notes/Instructions after Seminar
dfranklin:
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:
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:
Thank you so much DMK! This is great! It helps me a ton...
Thanks again!!!
dfranklin:
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:
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!
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