Chiropractic care focuses on diagnosing and treating neuromuscular disorders, primarily through manual adjustments and manipulations of the spine. It’s a holistic approach that emphasizes the body’s ability to heal itself, often without the use of surgery or medication. Chiropractic care is significant because it offers patients a non-invasive way to manage pain, improve mobility, and enhance overall well-being.

CPT (Current Procedural Terminology) codes are essential in the chiropractic industry for documenting medical services and procedures. For chiropractors, these codes ensure that services are accurately billed and reimbursed by insurance companies. Using the correct CPT code is crucial for compliance, preventing claim denials, and optimizing reimbursement.

In this blog, we have provided a detailed guide to 98942 CPT code, which is commonly used in chiropractic practices. We’ll explore when to use this 98942 procedure code, the challenges associated with it, and strategies to optimize its use for better reimbursement outcomes.

What is the 98942 Chiropractic Code?

98942 CPT code description as “Chiropractic manipulative treatment (CMT); spinal, five regions.” This code is used when a chiropractor performs adjustments on all five regions of the spine: cervical, thoracic, lumbar, sacral, and pelvic.

Specific Services Covered Under the 98942 CPT Code Description

According to the 98942 CPT code definition, the services covered under this CPT code include spinal adjustments and manipulative treatment for all five spinal regions. This code is reserved for cases where the chiropractor provides comprehensive care, addressing multiple areas of the spine in a single session.

Challenges of Using 98942 CPT Code

Accurate coding is vital in chiropractic practice to ensure that the services provided are properly documented and reimbursed. Misusing 98942 chiropractic code can lead to claim rejections, underpayment, or even denials, making it essential for chiropractors to understand and use this code correctly.

Common Misconceptions About the Code

One common misconception about 98942 CPT code is that it can be used for any chiropractic adjustment session, regardless of the number of regions treated. However, this code should only be applied when all five spinal regions are adjusted, as using it incorrectly can lead to compliance issues.

Issues with Documentation and Compliance

Proper documentation is a significant challenge when using 98942 procedure code. Chiropractors must meticulously record which spinal regions were treated and justify the necessity for adjusting all five regions. Inadequate documentation can result in claim denials or audits.

Potential for Claim Denials and How to Address Them
Claim denials often occur when CPT code 98942 is used without sufficient documentation or when the treatment does not meet the criteria for this code. To address this, chiropractors should ensure that their records clearly indicate the need for comprehensive spinal adjustments and include detailed patient notes.

[Also read: Timely Filing for Chiropractic Claims and How to Handle Claim Denials]

Optimizing Reimbursement for 98942 CPT Code

1. Strategies for Effective Billing Practices

To optimize 98942 CPT code reimbursemente, you should adopt effective billing practices, such as ensuring accurate coding, double-checking documentation, and submitting claims promptly. Working closely with billing professionals can also help in maximizing reimbursement.

2. Thorough Patient Documentation

Thorough patient documentation is crucial for justifying the use of CPT code 98942. Chiropractors should record detailed notes on the patient’s condition, the specific spinal regions treated, and the outcomes of the treatment. This not only supports the necessity of the treatment but also helps in case of an audit.

3. Tips for Communicating with Insurance Providers

Effective communication with insurance providers is key to preventing claim denials and resolving any issues that arise. Chiropractors should be proactive in contacting insurers to clarify any questions about the use of CPT code 98942 and to ensure that their claims are processed smoothly.

Important Things to Keep in Mind When Using CPT Code 98942

1. Use AT Modifier

For CPT codes 98940, 98941, or 98942, it’s essential to include an active treatment (AT) modifier. Without this modifier, the treatment won’t be considered medically necessary.

Use the following categories for additional secondary diagnosis:

• Category 2: ICD-10-CM codes for short-term treatment.
• Category 3: ICD-10-CM codes for moderate-term treatment.
• Category 4: ICD-10-CM codes for long-term treatment.

 2. Provide Detailed Documentation

The more detailed the documentation for a prescribed treatment, the better the outcomes for both patient care and billing accuracy. In healthcare, patient charts should be comprehensive and precise, including:

• The reason for the treatment.
• The treatment goals.
• Methods to track patient progress.
• Evidence of progress made.
• The complete treatment plan.

Thorough documentation not only enhances the quality of care but also ensures that your staff can accurately bill insurance providers.

3. Staying Updated

You and your biller must stay updated with the latest coding guidelines and regulations to use 98942 chiropractic code correctly. Regular training and continuing education can help in keeping up with any changes in coding standards.

4. Training Staff on Proper Coding Practices

Training staff on proper coding practices is essential for ensuring that CPT code 98942 is used correctly. This includes educating them on documentation requirements, the significance of accurate coding, and the potential consequences of misuse.

A common source of confusion arises when differentiating between the number of “segments or vertebrae” adjusted versus the correct number of regions.

For example, if a chiropractor adjusts C1, C3, C5, C7, and T4, this encounter should be coded as 98940, because these adjustments were made in only two regions. One of the most frequent coding errors occurs when such a visit is mistakenly reported as 98942. It’s important to remember that 98942 requires adjustments in all five distinct regions: cervical, thoracic, lumbar, sacrum, and pelvis.

5. Ensuring Patient Education on the Services Provided

Educating patients about the services provided under CPT code 98942 can enhance their understanding of the treatment they receive and why it’s necessary. This not only improves patient satisfaction but also supports the documentation process, as patients are more likely to recall and confirm the treatments provided.

Conclusion

Navigating the complexities of 98942 code in chiropractic care can be challenging, but with the right knowledge and practices, you can optimize reimbursement and ensure compliance.

By accurately documenting patient encounters, understanding the nuances of the code, and staying up-to-date with the latest guidelines, you can avoid common pitfalls such as claim denials and underpayments.

zHealth’s billing software is designed to simplify the entire process, making it easier for you to manage your billing process accurately and efficiently. With our advanced billing tools, you can focus on providing quality care while we handle the complexities of coding and billing.

Ready to streamline your practice’s billing? Request a free consultation with zHealth today and discover how we can help your practice thrive.

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