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Chiropractic coding

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mauletta:
What diagmosis codes should be used for cpt 98941 when CMT is performed on the cervical, thoracic and sacrum regions?

Pay_My_Claims:
what dx did the md give? You can't "find" a dx to justify billing, you bill the procedure according to the dx that he gave. A good biller will let his MD know that if this is what he is coding, then the ins may deny unless the patient actually has another issue.

Michele:
The diagnosis must come from the dr, like Charlene said.  But if you are billing Medicare you can make the dr aware that Medicare requires that the primary diagnosis must be a 739.x dx, and the secondary dx must be on the list of Medicare acceptable dx's.  You can't pick the dx's for them, and they can't pick dx's just to get the claim paid.  But you should make them aware so they can code appropriately for the patient.

For Chiros it's a little unusual because Medicare specifies what diagnoses they accept.

Michele

mauletta:
The problem is the dr. isn't sure what code to use for the diagnosis. Subluxation of the cervical, thoracic and sacrum region

DMK:
The subluxation (dislocation) codes (839.x) no longer work.  You must use the Segmental Dysfunction codes (739.x).  Michele is exactly right.  The 1st dx must be the 739.x (whatever area the patient's MAJOR complaint was, cervical, thoracic, lumbar), the 2nd code is the complicating factor and you can only use the ACCEPTED codes that Medicare uses. The 3rd dx should be the next area of complaint (739.x) and the 4th dx should be the next area of complaint (739.x). 

Now you have 3 areas so you can bill a 98941.  Be sure the doctor is aware that the 2nd diagnosis (the complicating factor) will determine how much treatment is medically necessary. 

Dina

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