Coding > Coding

Bundling of 97012

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Chiro Billing Collect:
Just recently, the Federal employee BCBS plans started bundling a spinal manipulation 98941 with 97012. They combine the charge, apply the allowable for 98941 and copay, and pay the balance resulting in an underpayment. They are stating that no separate reimbursement is due. The 97012 does not require a modifier under any circumstance, as far as I know, when billed with a spinal manipulation. Am I missing a recent change? Any thoughts would be greatly appreciated!
Thanks, Marisa

kristin:
Here is one thing I found:

http://www.acomhealth.com/resource/mechanical_traction_or_cmt/

Based on what that article says, it should be appealed, using the rationale they provide. Whether or not that will net any further payment, I do not know.

Perhaps someone who does chiro billing will have further insight for you.

Chiro Billing Collect:
Thank you Kristin! I sent a request for reconsideration noting the previous dates they paid at the allowable rate. If that doesn't work, I will have to send in a formal appeal and cite the article.

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