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Billing Question

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ballingervillagechiro:
I was just wondering when billing a 98943-51 on the same date of service as a 98940 or any other spinal code, is that considered (2) adjustments? My question stems from a discrepency with an insurance who claims a patient exceeded their benefit max, where they considered both the 98943-51, and the 98940 as 2 visits the same day? I wasn't sure if that applies to each insurance individually or if there is a rule that states otherwise, or confirms that it is infact properly billed? If anyone has any information about this, I would love to learn more about it! Thank you!

Michele:
It sounds like a plan guideline which is defined by the employer/plan.  I don't think there is anything you can do about that.  I would probably call to confirm that they counted it correctly.

CLAUDIA:
The 98943 code is an extremity adjustment, whereas the 98940, 98941 or 98942 codes are spinal adjustments.  The -51 modifier tells the insurance company this is an additional procedure, so technically it is an additional adjustment.  As Michele stated, it is probably a specific plan's guideline.  In all my 14 years of billing chiropractic claims, I have never used the -51 modifier on the 98943 code.  I would suggest that you try billing this code without the modifier.  I think the key on this procedure is that the diagnosis corresponds to the extremity adjustment - such as brachial issues or radiculitis.

Pay_My_Claims:
well well, i know where to go when I land my chiro dr. you guys are great

DMK:

--- Quote from: Georgia Girl on June 30, 2010, 11:26:43 PM ---The 98943 code is an extremity adjustment, whereas the 98940, 98941 or 98942 codes are spinal adjustments.  The -51 modifier tells the insurance company this is an additional procedure, so technically it is an additional adjustment.  As Michele stated, it is probably a specific plan's guideline.  In all my 14 years of billing chiropractic claims, I have never used the -51 modifier on the 98943 code.  I would suggest that you try billing this code without the modifier.  I think the key on this procedure is that the diagnosis corresponds to the extremity adjustment - such as brachial issues or radiculitis.

--- End quote ---

Agreed, -51 is for additional procedure, as long as you have your dx in line to justify the extremity adjustment it's billable w/o the -51.  It seems funny, though, for the insurance company to be considering this as 2 "visits" when they're the same day.  Usually when you verify coverage it's shown as "24 visits p/ year" not 24 adjustments p/year". 

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