Coding > Coding

2 questions on chiropractic billing


I have two questions I was hoping you might be able to answer. 1.The Chiro that I work for usually codes 3 units of theraputic exercises (97110), even though the patients are only here for 15-20 minutes. I have heard several different explanations regarding how the number of units is determined but what is the correct way? 2. There are some things that he does that I am not comfortable with, such as discounting co-pays and co-insurance for patients who do not qualify for hardship agreements, tells patients the initial consult is free and then bills their insurance anyway or refuses to tell patients they have credits on their accounts. I've tried talking to him about these things but to no avail. I'm concerned that I could get in trouble for these things if they are reported but I can't afford to quit right now. Any advice? -Randi

Hi Randi,
Wow, you are in a tough position! Well, first, on the 97110 code, the CPT book published by the American Medical Association states that the 97110 is to be used 1 unit for each 15 minutes of therapeutic procedure, one or more areas. Your doc probably feels that if he is doing a therapeutic procedure on three different areas, that he can use 3 units, but that is not how I interpret the book. As for question #2, there are some issues with those practices. I'm not sure where you are located, but in our area, the insurance company contracts that the provider signs states that the provider MUST charge ALL patients for their copays/coinsurance amounts. If they don't then they are breaking their contract and the insurance company can terminate them as a provider. However, in 15 years, I haven't seen that done. Also, technically, there is no actual ‘hardship clause.’ We recently asked a local Blue Cross provider rep about this. They turn there backs on the practice and look the other way, but there is no hardship clause. We bill for a chiro who wanted to be able to offer patients whose insurance denied the charges a lower rate, and the only way around it was to have a sliding fee schedule offered across the board to all patients. It had to be concrete and in writing. Also, if he tells a patient that a service is free, then bills the insurance, he risks the patient reporting him to the insurance company. That will most likely result in a fraud investigation. The good news for you is that you can't get into trouble for the actions that he is doing. He is responsible for all billings that go out, and any mistakes (whether accidental or on purpose) that go out on them. However, for your sanity, you may want to begin your job search while you still have your integrity. Good Luck Michele


[0] Message Index

Go to full version