Coding > Coding

Diagnosis Ordering (Chiro)

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Csinsay:
Hi,

Can someone please explain Dx Ordering.  I have been hearing different things. 

For Chiropractic Specialty, this is what I typically follow:
1. Neurological and Pain Syndromes
2. Subluxation
3. Structural and Functional Disorders
4. Unspecified Conditions, Muscular Conditions and Congential Anomalies

Thanks!

DMK:
It depends on who you're billing.

Medicare is VERY specific.

Use 739.X for the first dx, for the area of major complaint.   .1 for Cervical, .2 for Thoracic, .3 for Lumbar.
They do not accept subluxation codes anymore. 

The 2nd dx is the complicating factor.  The CMS web site has a printable list of the ONLY acceptable conditions for medical necessity.

The 3rd dx is 739.X if there is an additional area being worked on.

The 4th dx is 739.x if there is another area being worked on.


All other insurance should use 739.x codes 1st to show a 1-2 area or 3-4 area, or extremity being adjusted.  Then the complicating factors. Sprain/strain, headache, muscle spasm etc.  The insurance companies want to see the areas being worked on to verify the procedures being performed, then the complicating factors.

Csinsay:
Thank you DMK.  How about for commercial insurance carriers like Blue Cross, Cigna, etc?

Michele:
I have found with commercial insurances they do not require any specific ordering of diagnosis for chiropractors.

DMK:
Correct, they don't require specific ordering, but bear in mind that you have to have diagnosis to match what procedures you're billing for.

If you are billing for adjusting 3-4 areas, you can't show 724.2 (lumbago), 739.3 (Lumbar Intersegmental Dysfunction), 847.2 (Lumbar Sprain/strain), and 724.4 (Leg Radiculitis) and expect to get paid for a 3-4.  Those are all diagnosis for 1 area.  You need to show all the regions be worked on.  If you're billing a 3-4 and an extremity adjustment then the 4 dx's that will show up on the HCFA should be for the 3 regions and the extremity being worked on. Does that make sense?

It's most important (at least in Chiropractic billing) to show the AREAS being worked on, then the complicating factors.  With other medical providers, I'm sure, it's totally different.

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