Successful chiropractic coding and billing practices have a number of elements in common. They include savvy practice management, healthy accounts receivables, a properly trained staff, and the ability to properly code and document diagnoses – and that’s just for starters.
We’ve compiled our best resources to help you navigate the complicated landscape of chiropractic medical billing. Whether your main goal is to increase monthly revenue, decrease your denied claims, or simply improve your practice.
CPT coding for mechanical traction versus CMT
Why some payers are denying Mechanical Traction (CPT Code 97012) on the same date of service as the Chiropractic Manipulative Treatment (CMT 98940-98942).
Some payers are denying Mechanical Traction (CPT Code 97012) on the same date of service as the Chiropractic Manipulative Treatment (CMT 98940-98942).
Here is the rationale of one payer: “…both mechanical traction and spinal manipulation on the same date of service as the procedures, for all intents and purposes, are redundant. Manipulation and mechanical traction are designed to mobilize joints, increasing segmental motion and restoring appropriate spinal biomechanics. Inasmuch as the procedures are essentially duplicative, either spinal manipulation or mechanical traction would be appropriate on an office visit encounter, but not both on the same date of service.”
They are not the same. Such a rationale (or denial tactic) implies that DCs should trade-in their adjusting tables for another intersegmental traction table.
From a CPT® coding perspective, 97012 is a physical medicine mechanical traction modality that does not require attendance. Various other modalities might also assist in accomplishing and/or complementing some of the same objectives as the CMT codes or 97012. However, that does not make them duplicative. Additionally, the CMT services are in a different section of the CPT code book and are unique manual techniques that require physician attendance.
Furthermore, the descriptions of these codes from CPT do not match with such an assessment.
Remember that CMT is an “umbrella” term, meaning that there are many, many different techniques that are utilized by chiropractors that are billed with the CMT code. For example, an upper cervical practitioner might only adjust C1-C2, bill 98940 and utilize 97012 for rest of the body. The same can be said of the Activator method and many other techniques where the service has different objectives.
Further appeals rights exist within ERISA law (health plans sponsored by an employer in the private sector). From this perspective, the payer could be forced, upon denial, to produce all evidence, including research, as the basis for their denial.
- Refuse to accept the denial and make an appropriate appeal.
- Give them the rationale stated above.
- When such cases are ERISA type claims, and you have the patient’s authorization as their representative, demand documentation that supports their “adverse benefit determination
Professional Chiropractic Billing ServicesOutsourced chiropractic billing services can relieve the burden of in-house billing, so your office staff can spend their energy and time on what matters: patient care. In addition, billing experts – coupled with effective software – can help improve your cash flow, practice productivity and patient experience.
Explore whether partnering with insurance billing experts is right for you. Some of the benefits include:
- Increased reimbursements
- Quicker claim payments
- Reduced billing headaches
- Eliminated billing errors
- Steadier cash flow
- Increased patient retention
Medicare & Medicaid Chiropractic Billing
There are actually no limits or caps in Medicare for covered chiropractic care provided by chiropractors, as long as they meet Medicare’s licensure and other requirements detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 30.5.
Just because you’re a non-par doesn’t mean you don’t have to bill Medicare. All Medicare Part B covered services must be billed to Medicare by the provider (or the provider can face penalties). This is known as the Mandatory Claim Submission Rule.
One exception to this rule is when the beneficiary has signed a valid Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, with Option 2 selected. To find out more about what a non-provider is, and how they can choose to accept assignments on claims, consult the CMS fact sheet.