One of our managed billing consultants received this question: “I have noticed that my insurance reimbursements are decreasing. I see a lot of patients but I am not getting paid what I deserve. What could be the reason?”
We get it. It’s frustrating when a provider performs chiropractic services and does not get paid enough for the rendered services. What to do? It all comes down to the ABCDEs of chiropractic coding.
1. A -Accurate Coding
Coding accuracy matters because it ensures the provider is telling an accurate story of the patient’s health condition with codes. To ensure accurate coding, providers need to establish an understanding of chiropractic Current Procedural Terminology (CPT) codes and ICD-10 codes and learn how to use the coding resources available when choosing chiropractic codes.
The easiest way to be accurate while coding is to provide a service — and then find the best code for that service. The final code selections should always be based on the chiropractic documentation in the patient’s encounter record.
There are two ways to accurately choose codes and get properly reimbursed:
a. Use chiropractic coding resource manuals to confirm details about the codes utilized. Check out these resources to ensure accurate coding:
- https://www.acatoday.org/Practice-Resources/Coding-Documentation/ICD-10
- https://www.ama-assn.org/practice-management/claims-processing/icd-10-overview
- https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
b. Outsource your coding and billing processes to expert billing service providers. Chiropractic billing professionals have in-depth knowledge and experience in processing claims. They are experts in helping you achieve an enviable success rate in claim reimbursements.
2. B – Be up to date with coding changes
Chiropractic CPT codes for billing are updated annually for use on 1st January of each year. Therefore, staying up to date with coding changes help providers select the right CPT and ICD-10 codes during patient visits. As of January 2021, here are the chiropractic coding changes that happened and chiropractors must know about them (Source of Images: NCMIC):
a . Providers need to select evaluation and management (E/M) codes based on the “Total Time Spent on the Date of Encounter.”
b .The Relative Value Units (RVUs) have increased on most of the E/M codes. Medicare and most insurance companies use RVUs for claim reimbursements. Here is a comparison of reimbursement amounts for the most commonly reported E/M services for 2020 and 2021:
| Year | 99202 | 99203 | 99204 | 99212 | 99213 | 99214 |
| 2021 | $73.97 | $113.75 | $169.93 | $56.88 | $92.47 | $131.20 |
| 2020 | $77.23 | $109.35 | $167.09 | $46.19 | $76.15 | $110.43 |
| Year | 97012 | 97014 | 97035 | 97110 | 97124 | 97140 |
| 2021 | 0.43 | 0.39 | 0.42 | 0.87 | 0.85 | 0.80 |
| 2020 | 0.43 | 0.41 | 0.41 | 0.87 | 0.83 | 0.80 |
c .99205 is the highest-level code of 99205 (60-74 minutes). Now, there is a new code that can help you get paid for the extra 15 minutes using the new Prolonged Visit CPT code 99417. There is an exception when billing Medicare for this code. Providers need to use HCPCS code G2212 instead of 99417.
3. C – Complete Documentation
Documentation should be provided in detail to support the level of service reported. It is recommended to document everything at the time of service to maintain an accurate patient record.Be sure to include the start and end times of the service provided. For example, when using the most common CPT codes 98940-98943, providers need to follow the below-mentioned documentation requirements:
| CPT Code | Documentation Requirements |
| 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions | – A complaint involving at least one spinal region – An examination of the corresponding regions – Pre manipulation assessment (review of imaging, physical examination documentation) – A diagnosis and manipulative treatment of conditions involving the affected region(s). The claim must record a diagnosis code relative to the applicable region – Response/Outcomes to Treatment – Plan for Ongoing Care |
| 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions | – A complaint involving at least three spinal regions – Pre manipulation assessment (review of imaging, physical examination documentation) – A diagnosis and manipulative treatment of conditions involving at least three spinal regions – Response/Outcomes to Treatment – Plan for Ongoing Care |
| 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions | – A complaint involving five spinal regions – Pre manipulation assessment (review of imaging, physical examination documentation) – A diagnosis and manipulative treatment of conditions involving five spinal regions – Response/Outcomes to Treatment – Plan for Ongoing Care |
| 98943 Extraspinal, 1 or more regions | – A complaint involving one of these regions – An examination of the corresponding regions – A diagnosis and manipulative treatment of conditions involving the affected region(s) – A diagnosis code relative to the applicable region(s) – Your examination findings |
We have just mentioned the documentation requirements for the most commonly used CPT codes by chiropractic providers. Similarly, providers are required to provide complete documentation when using other CPT codes. That’s where having an all-in-one chiropractic software solution is so valuable.
Chiropractic software comes integrated with EHR, customized SOAP notes, and billing software. This helps to document subjective complaints, objective measures for patient progress, assessment, outcomes to treatment, and treatment goals and plan with just a few clicks. Your SOAP notes are legible and remain compliant with documentation requirements. It also takes away the guesswork at deciphering handwriting and limits errors.
4. D – Develop financial policies
Insurance billing and claim submission is a part of your revenue cycle. To ensure the revenue graph goes up every month, providers need to develop financial policies. Having clear office procedures in place making the insurance billing process much easier. We created chiropractic billing strategies that can help providers get started with their own financial policy. To cover your bases, here are some things you need to know:
• The majority of your patients will have insurance that covers chiropractic services. Make sure to verify coverage before billing.
• Patients must be informed about their financial responsibility. If they don’t have insurance for chiropractic treatment, they should be asked to sign an acknowledgment form that they agree to pay for all services and products.
• Ask patients for payment before or immediately after the patient’s visit.
• If some of your claims are being denied, do appeal them. The American Chiropractic Association (ACA) states that, “It is vitally important to the chiropractic profession and your patients that you appeal all denials, whether they are pre-service restrictions, restrictions of continued care, or down-coded and bundled claims.” For appeal resources and samples of appeal letters, visit the ACA website.
5. E – Evaluate coding patterns and analyze billing reports
It is recommended to examine monthly billing reports to get some meaningful insights that will be helpful in evaluating billing functions. If you’re using chiropractic billing software, evaluating your billing performance becomes much easier. If your billing process is outsourced, your service provider should give you these chiropractic billing reports every month. You should look into these reports to monitor trends and find out where improvements are necessary.
• Accounts Receivable (A/R) for Patients and Insurances: How many accounts are in A/R, and how long have they been there?
• Payments Reports: Use the payments reports to view information about payments received and posted; as well as information about copays/coinsurances, adjustments, and denials.
• Detailed Payments and Charges Reports: Coding regulations change and so do the service you provide over a period. With these reports, see what codes you’re using more frequently. Look at your top billed codes overall and by insurance payor.
Conclusion
Chiropractic providers treat a variety of patient types – new, existing, report findings, and so on. With each new encounter with a patient, the chiropractic codes for billing change. When providers know the ABCDEs of chiropractic coding and billing, they can maximize the reimbursements and minimize claim rejections or denials.
If you want experts to handle your chiropractic billing process, contact zHealth that provides complete chiropractic billing services including chiropractic coding, denial management, and AR follow-up. Call +1 (800) 674-2908 or send your queries to [email protected].
