Tips for Chiropractic CPT Codes for Better Insurance Reimbursements

Stay up to date with code changes

Practicing chiropractors need to know almost as much about chiropractic billing codes as they do about their patients. CPT codes for chiropractic services are revised and updated throughout the year. Chiropractic practices need to stay updated and current with the chiropractic billing code changes. For instance, the CMS guideline for chiropractic billing and coding states that “The AT modifier must not be placed on the claim when maintenance therapy has been provided. Claims without the AT modifier will be considered as maintenance therapy and denied.” If your billing staff feels overwhelmed with the constantly changing insurance billing landscape, hiring chiropractor billing services will help you avoid claim denials or rejections due to coding errors or insufficient documentation.

Well-documented patient record

To ensure your practice follows a smooth insurance billing process, it is crucial to maintain well-documented patient charts and paperwork. From insurance records, and patient demographics to diagnoses and procedures performed, make sure you maintain an accurate patient record to get the maximum reimbursements for the services rendered. Use integrated EHR and chiropractic billing solutions to manage patient records and billing effectively.

CPT coding for mechanical traction versus CMT

CPT Code 97012 is used for coding mechanical traction, most often for the lumbar or cervical spine to relieve pain and improve tissue flexibility. Chiropractic Manipulative Treatment (CMT) codes (98940-98943) include a pre-manipulation patient assessment, the adjustment, and the evaluation of the effect of treatment. Based on the guidelines for chiropractic billing codes, CMT and mechanical traction should be used carefully when billing insurance companies. Some payers deny chiropractic CPT codes for billing Mechanical Traction services rendered on the same date of service as the CMT treatment. Before submitting your claims, you must know the chiropractic coding rules and requirements for different payers.

Analyze your billing reports and denials

Analyzing your billing reports will help you identify how much you’re being paid by payers for each chiropractic therapy CPT code. If you have denied claims, make sure to check what went wrong. Analyzing chiropractic CPT codes for billing in denied claims can help you find patterns that can be corrected in the future to prevent losses. However, when you outsource your chiropractor billing services to zHealth, you get access to verified professionals who will submit your claims on time to make continual cash flow and an assured increase in revenue and take care of your claim denials. 

What are Chiropractic ICD-10 Codes?

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD -10- CM) codes help to determine which type of treatment a provider needs to offer and what needs to be addressed. Using valid chiropractic ICD-10 codes can facilitate accurate claims payments and support the medical necessity of the service. One of the most common chiropractic ICD-10 codes is the vertebral “subluxation.” It is the diagnosis that is used to justify the performance of a chiropractic manipulative treatment or an adjustment.

ICD-10 codes for chiropractors have seven characters, which represent Section, Body System, Root Operation, Body Region, Approach, Method and Qualifier.

• The first three characters denote the category. All ICD-10 codes for chiropractic treatment under the same category are related to conditions.
• The next three characters specify anatomical site and severity.
• The seventh character in ICD 10 chiropractic codes is used to denote encounters, including Initial Encounter, Subsequent Encounter, or Sequela. 

Importance of ICD-10 Codes for Chiropractors

ICD-10 codes for chiropractic are the standard transaction code set used by providers for diagnostic purposes under the Health Insurance Portability and Accountability Act (HIPAA). The code set is used for finding health care statistics, quality outcomes, mortality statistics, and billing. Understanding and educating yourself and your staff on appropriate coding will result in fewer claim denials, spending less time spent with payers trying to justify your claims, and a higher revenue stream. 

General Tips for Coding Chiropractic ICD-10 Codes Effectively

Find the most specific code

With tens of thousands of ICD-10 codes, it will be virtually impossible to memorize them all. If you’re using chiropractic billing software, it will be easier to locate the code by just typing the first few letters of the diagnosis. The software will auto-populate the relevant codes based on your entered letters. Review the auto-populated results to find the most specific ICD 10 codes for chiropractors.

Identify the highest specificity

Official guideline for chiropractic billing and coding requires ICD-10 coding to the highest degree of specificity. Chiropractic providers have an obligation to document conditions to the full extent of their knowledge of the patient’s health. When you hire managed billing services, professional coders will ensure that you have assigned and reported ICD-10 codes for chiropractic services with the highest degree of specificity.

Document Chiropractic Diagnosis Codes Supporting CPT Codes

Insurance companies pay for procedures (CPT codes), not chiropractic diagnosis codes. But ICD-10 codes for chiropractic should be used to support chiropractic therapy CPT codes. When billing CPT codes, a provider must connect or “point” the diagnosis to each procedure performed. Remember, the total number of diagnosis pointers per CPT code is limited to four. 

Chiropractic Modifier Codes

In English, a modifier may describe the who, what, how, why, or where of a situation. Similarly, modifier codes help chiropractors to indicate that a service or procedure has been altered due to some specific or unusual circumstance, such as why that procedure was necessary, where the procedure was performed on the body, what other services you used to complete the procedure, and so on.

There are various chiropractic modifiers that chiropractors can use when reporting chiropractic services. The modifier code is added to the CPT code with a hyphen and not to the ICD 10 chiropractic codes. If your selected CPT code requires a modifier and you fail to include it, your claim will be rejected by the insurance company.

A Complete Guide to Chiropractic Billing

How do chiropractors bill insurance?

1. Requirements

Coding descriptions and instructions are provided and maintained by the American Medical Association’s (AMA) Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) developed by the Centers for Medicare and Medicaid Services (CMS).
All chiropractic services must be performed by a licensed provider. If services are performed by your chiropractic assistants (CAs), massage therapists, or other unlicensed providers under your direct supervision by a licensed chiropractor are not eligible for reimbursement.
Chiropractic services are subject to current procedural coding edits. Chiropractors must use modifiers when deemed necessary for billing insurance companies. Please check the CPT codes and ICD 10 codes for chiropractic Medicare and other payers provided above.

To bill insurers and get proper reimbursements, you must establish medical necessity for any treatment you provide. Medical necessity is any treatment, service, or test required after patient diagnosis, which may be justified as reasonable or necessary based on evidence-based standards of chiropractic care. It should be noted that Medicare and private insurance companies have different criteria to determine whether a given procedure, treatment, service, or test is a medical necessity or not.

For instance, Medicare Part B (Medical Insurance) covers manual manipulation of the spine provided by a chiropractor if medically necessary to correct a subluxation. Medicare doesn’t cover some ICD 10 codes for chiropractic services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture.

2. Chiropractic Coverage

Chiropractic coverage includes evaluation and management (E&M) services, radiology, chiropractic manipulative treatment, and modalities and procedures according to the reimbursement policies of insurance companies and Medicare.
When you perform diagnostic imaging services to find more information regarding the patient in terms of diagnosis, prognosis, and therapy planning, you must provide documents to bill and receive reimbursement for the same.

3. Documentation of Patient Records

Complete documentation of your patient’s history, treatment plans, tests and services, and patient statements is an essential component of proper billing and getting timely reimbursements. You must follow the standards for documentation and chiropractic records:
As a chiropractic practice, you must establish and maintain a separate and accurate treatment record for each patient.

Each patient entry shall be dated and signed by you. Such records shall be legible to review by a reviewer or auditor.

Documentation requirements for initial visits:

• The patient’s case history: Document the primary complaint of your patient. Apart from the main symptoms he or she is facing, you must document the patient’s family history, significant illnesses, and medical conditions, past medical history, medical allergies, and adverse reactions.
• Description of the present illness: Mention detailed information regarding the present health problem the patient is facing, such as quality and character of symptoms, onset, duration, intensity, frequency, location, and radiation of symptoms, aggravating or relieving factors, prior interventions, treatments, and medications are taken, secondary complaints, and main symptoms that caused the patient to seek treatment.
• Evaluation of musculoskeletal/nervous system through physical examination: Evaluation through physical examination is necessary to identify if there is subluxation that requires intervention and treatment. Follow the PART criteria to document evaluation findings:

P: PAIN and tenderness. Observe, examine, and document the pain exhibits with information about the intensity, location, and quality. Mention percussion, palpation, or provocation, pain grading scale, or audio confirmation by the patient, or include a questionnaire to describe their pain.

A: ASYMMETRY or misalignment. You can observe or notice patient posture or analyze gait, describe the spinal misaligned vertebrae and symmetry, and use and attach x-ray, CAT scan, or MRI result to identify misalignments.

R: RANGE of Abnormal Motion. You must diagnose and document the patient’s range of motion and record your palpation findings observation in a section or segment.

T: TISSUE TONE, TEXTURE, or TEMPERATURE. Observe and examine the abnormality in the soft tissues of the body, such as signs of spasm, inflammation, swelling, temperature changes, hypertonicity, hypotonicity, tautness, rigidity, and more. Document the instrument used and the findings.

• Diagnosis: Chiropractors are reimbursed for their claims only when the primary diagnosis for a patient is found to be subluxation. The precise level of the subluxation must be specified by the doctor of chiropractic. The document for specifying subluxation in the patient’s record must include the number and area of the spine, the ilii with the sacrum as an area where the patient has a condition, and the subluxation ICD-10 code.
• Treatment plan: The treatment plan must include the recommended level of care, specific treatment goals, and objective measures that can determine the effectiveness of the treatment.
• Informed consent or terms of acceptance by the patient
• SOAP notes for each patient encounter (Subjective, Objective, Assessment, and Plan notes)
• Date of initial treatment
• Details of supportive procedures or therapies, when administered, dispensed, or prescribed 

Documentation requirements for subsequent visits:

1. Patient History: Chief complaint, changes since the last visit, and review if relevant

2. Physical examination: Examination of the spinal area involved in the diagnosis, assessment of change in patient condition since the last visit, and evaluation of treatment effectiveness.

3. Documentation: Document any treatment given on the day of the visit.

“I had never done my own billing before, but I have been doing it pretty seamlessly by myself since April when I started using zHealth chiropractic insurance billing software.”

The Step-by-Step Claim Submission Process

Benefits of Chiropractic Software for Insurance Billing Automation

Billing software for chiropractors is the core of your chiropractic practice. In today’s value-based care healthcare environment, the decision to utilize technology to support the billing process can have a long-lasting effect on the financial health of your practice. Consider using chiropractic insurance billing software. Why? Chiropractic medical billing software helps you get the best acceptance rates on your first submission, auto post ERAs, advanced claim scrubbing functionality, and automatic claim creation after you sign the SOAP note.

Using HIPAA-compliant chiropractic billing software that supports the in-house billing-claim-collections cycle management process is your best path forward. Even better, hiring one of the best chiropractic billing companies saves you tons of time and hassles while increasing revenue. Chiropractic medical billing services providers stay on top of their game with the latest knowledge of the coding rules and regulation changes by insurance companies. So you can submit accurate claims in a timely manner and get full reimbursements.

zHealth software automates your documentation process, insurance billing, and claims processing workflow.

• zHealth’s online patient check-in feature allows patients to fill in their information online with all submitted information going directly into the electronic health record system. zHealth Software has an integrated billing system. You save a lot of time and avoid making mistakes by automating the patient intake forms.
• zHealth’s EHR system features the best chiropractic billing software that allows providers to access a patient’s insurance information with a few clicks.
• zHealth SOAP Note templates and dictation feature allow you to properly document subjective, objective, assessment, and treatment plans.
• The chiropractic insurance billing software by zHealth is ICD-10 compliant. No need to search for CPT codes in a sheet as you can easily create patient statements with a few clicks.
• With zHealth’s automation feature in chiropractic billing software, submit the claims automatically and keep track of your collections.
• zHealth offers the best chiropractic billing services for clinics looking for professionals to handle their claims and billing processes. If you want to see how the best chiropractic billing software helps you save time and money, request a free demo now!

FAQs Related to Chiropractic Medical Billing and Coding

Q: What are the covered chiropractic services under Medicare?

A: Spinal manipulation treatment is a covered service under Medicare. However, Medicare considers only acute and chronic services as active care, and therefore, reimburse chiropractors for these services.

Q: Can I bill for maintenance therapy give to my patients?

A: Medicare only covers acute/corrective treatment to correct acute or chronic subluxation. Medicare does not cover CPT code for chiropractic maintenance.

Q: Do I need to submit a secondary diagnosis during claim submission?

A: Claim submission must include a primary diagnosis of subluxation and a secondary diagnosis reflecting the patient’s neuromusculoskeletal condition. You must document everything related to the services provided to support your claims.

Q: Can I use pain levels to support the acute or chronic category of subluxation?

A: No, you must clearly define the acute or chronic category of subluxation in the patient’s record.

Q: Should I document the effectiveness of the treatment for all subsequent visits for a patient?

Ans: Yes, the documentation must indicate an evaluation of the effectiveness of the treatment provided for all subsequent visits.

Q: Do insurance companies deny claims for chiropractic services based on medical necessity?

A: Insurance companies request chiropractors to send medical records to substantiate the chiropractic services rendered to a patient. If you met the documentation requirements, the claim reviewers send the documentation to a consultant to determine the medical necessity of the services. The insurers can deny claims if they didn’t deem a procedure medically necessary.

Q: How can a subluxation be demonstrated?

A: A subluxation may be demonstrated by an X-Ray or by physical examination.

Q: What is modifier AT and when do I report it?

A: Modifier AT tells us the difference between active treatment and maintenance treatment. When you’re billing Medicare, use AT modifier only when you bill for active/corrective treatment. Claims that do not contain modifier AT will be denied. AT modifier should not be used with CPT code for chiropractic maintenance.

Q: Is there a visit limit for chiropractic services as per Medicare?

A: There is no limit in Medicare for covered chiropractic care services as long as you meet Medicare’s licensure and other requirements.

Q: Is participating and non-participating chiropractors have different documentation requirements?

A: The chiropractic industry has specific documentation requirements. Your participating status nothing to do with documentation requirements. Make sure you stay compliant with HIPAA for maintaining and storing patient data. 

Check zHealth Software related FAQs here.

Additional resources:

• https://www.cms.gov/training-education/medicare-learning-network/resources-training
• Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits (PDF) MLN Matters Article
• Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449) (PDF) MLN Matters Article
• Educational Resources to Assist Chiropractors with Medicare Billing (PDF) MLN Matters Article
• Medicare Benefit Policy Manual, Chapter 15 (PDF), Sections 30.5 and 240
• Medicare Claims Processing Manual, Chapter 12 (PDF), Section 220

Disclaimer: This is general information about how chiropractic billing company works. Review the chiropractic coverage, requirements, reimbursements, and guidelines of insurance companies by contacting them directly.