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Chiropractic - Articles

Medicare Supplemental Policies (MediGap) and Extremity Adjustments
February 25th, 2019 - Wyn Staheli, Director of Research
The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...
Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?
February 22nd, 2019 - Wyn Staheli, Director of Research
It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?
Physical Therapy Caps Q/A
February 1st, 2019 - Wyn Staheli, Director of Research
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
Dry Needling
January 3rd, 2019 - Wyn Staheli, Director of Research
The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...

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Flexion-Distraction Billing Clarification
December 20th, 2018 - Wyn Staheli, Director of Research
Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ...
No Good Deed Goes Unpunished
November 28th, 2018 - Dr. Ray Foxworth, MCS-P, President of ChiroHealthUSA
You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.
CMT Fees in 2019
November 26th, 2018 - Wyn Staheli, Director of Research
Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are.
Muscle Testing and Range of Motion Information
November 8th, 2018 - Wyn Staheli, Director of Research
Be sure to understand the unique code requirements for Muscle and Range of Motion Testing.
Q/A: Does My LMT need an NPI? How do I Bill Her Services?
October 22nd, 2018 - Wyn Staheli, Director of Research
Question: I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, ...
Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder
October 19th, 2018 - Wyn Staheli, Director of Research
The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...
Chiropractic OIG Audit Recommendations - Lessons Learned
September 28th, 2018 - Wyn Staheli, Director of Research
The OIG recently concluded an audit on a chiropractic office located in Florida and had some significant findings. They recommended the following: Refund to the Federal Government the portion of the estimated $169,737 overpayment for claims for chiropractic services that did not comply with Medicare requirements and are within the 4-year ...
2019 Code Changes are Just Around the Corner - Are You Ready?
September 24th, 2018 - Wyn Staheli, Director of Research
The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...
Importance of Depression Screenings
August 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Q/A: Can I Bill Mechanical Massage?
August 16th, 2018 - Wyn Staheli, Director of Research
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
Q/A: How Do I Release a Patient from PI When They Still Have Problems?
August 10th, 2018 - Wyn Staheli, Director of Research
Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs? We have discussed this with several different experts. The consensus is....
Q/A: Can I Bill Spinal Decompression Table to Insurance?
July 25th, 2018 - Wyn Staheli, Director of Research
Are visits when a Chiropractor just uses a spinal decompression table billable to insurance? If so, what code is recommended?
Q/A: Can You Swap Out 97140 with 97530?
July 12th, 2018 - Wyn Staheli, Director of Research
Codes 97140 and 97530 are not interchangeable. See why.
Q/A: Should I Bill Massage as 97124 or 97140?
June 20th, 2018 - ChiroCode
Question The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
June 18th, 2018 - Wyn Staheli, Director of Research
Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.
Q/A: Am I Supposed to List the Frequency and Duration on the ABN?
May 22nd, 2018 - Wyn Staheli, Director of Research
How to fill out Box D (Services) on the ABN form. What information is required?
Will Chiropractors Benefit from Medicare's Proposed Reformations?
May 7th, 2018 - Wyn Staheli, Director of Research
Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards value based payment systems, new models are being sought to both reduce costs and increase quality. This article outlines some of the ideas presented in the RFI which ...
Q/A: How Do I Respond to a Patient's Request to Not Submit the Claim to Their Insurance?
May 7th, 2018 - Wyn Staheli, Director of Research
A number of patients now have high deductible plans. Sometimes, deductibles can be $5000 or $10,000. My payer contract states that I must submit all claims to insurance for covered services. However, sometimes patients with these high deductibles come to my office and state that they would prefer to receive a modest discount for paying cash and in turn, not have their services submitted to insurance. As a doctor, this places me in a tough situation. Do I follow the patient's wishes or the payer contract?
Q/A: What Code do I Use for Supraspinatus and Infraspinatus Tendonitis?
May 7th, 2018 - Wyn Staheli, Director of Research
Is there a better code for supraspinatus and infraspinatus tendonitis than the one for a rotator cuff tear?
Q/A: Should I be Using Modifier 96 on PT Claims?
April 30th, 2018 - Wyn Staheli, Director of Research
As chiropractors we feel the new modifier 97 is more appropriate than 96 for our PT codes such as stim and traction. Yet Carefirst is asking for 96 only. Should we use this code on all the PT codes and for all the other insurance companies?
When is 97112 Neuromuscular Re-education Billable?
March 13th, 2018 - Dr. Evan Gwilliam, VP for PayDC
Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.
OIG Issues Renewed Focus on Chiropractic Services
February 26th, 2018 - Wyn Staheli, Director of Research
The OIG recently released a "Portfolio" regarding chiropractic service which stated (emphasis added): This portfolio presents an overview of program vulnerabilities identified in prior Office of Inspector General (OIG) audits, evaluations, investigations, and legal actions related to chiropractic services in the Medicare program. It consolidates the findings and issues identified in ...
Q/A: With a Maintenance Patient of Medicare age that has a Medicare Replacement Plan (Part C), do They Need to Fill out an ABN?
February 26th, 2018 - Wyn Staheli, Director of Research
Q/A: With a maintenance patient of medicare age that has a medicare replacement plan (Part C), do they need to fill out an ABN?
Consultation Codes Q/A
February 20th, 2018 - ChiroCode
Question Are there consultation codes that can be used for new and existing patients when a review of systems and detailed history is performed but no examination due to the patient's reluctance to make a decision to continue with the visit but has taken up 30-45 minutes of the doctors time?
Medicare Requiring Modifier GP on Physical Therapy Services
February 1st, 2018 - Wyn Staheli, Director of Research
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following (emphasis added): Services furnished under the Outpatient ...
Strapping and Kinesio Taping Coding Differences
February 1st, 2018 - Wyn Staheli, Director of Research
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally. Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue. Coding: ...
Traumatic Subluxation Coding Controversy
February 1st, 2018 - Wyn Staheli, Director of Research
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
QCC FAQs
January 17th, 2018 - ChiroCode
Qualified Chiropractic Coder (QCC) certification FAQs: What's on the test? What score do I need to pass? How long is the test? How many times can I take the test? Can I use my books? And other questions.
Billing with a GP Modifier
January 15th, 2018 - Wyn Staheli, Director of Research
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
New MIPS Reporting Option for 2017 Data
January 11th, 2018 - Wyn Staheli, Director of Research
If you were eligible clinician in 2017, this new reporting method could help you.
Summary of OIG Reports for Chiropractic
October 23rd, 2017 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...
Medicare Improper Payment Report for Chiropractic (2016)
September 1st, 2017 - Wyn Staheli
The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ...
Quality Measures for Chiropractic - 2017
August 29th, 2017 - Wyn Staheli
Performance Measurement Codes for Chiropractic: Although there are hundreds of Performance Measurement (PM) services and events, only two may be reported for chiropractors for the 2017 reporting year. Pain Assessment and Follow-Up 131 ENCOUNTER: 90791, 90792, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 96116, 96118, 96150, 96151, 97161, 97162, 97163, 97164, 97165, 97166, 97167, ...
CAM Cost Considerations for Chiropractic Tenants
August 17th, 2017 - By Jeff Grandfield and Dale Willerton – The Lease Coach
Readers of our new book, Negotiating Commercial Leases & Renewals FOR DUMMIES, will learn (in-part) that Common Area Maintenance (CAM / Operating Cost) charges for tenants come in two flavors: honest mistakes or dishonest calculations. In a building where the property is fully or close to fully occupied, the landlord ...
Looking at Site Selection Variables – For Chiropractic Tenants
August 17th, 2017 - Jeff Grandfield and Dale Willerton – The Lease Coach
When you’re looking for the right property for your new chiropractic practice or wish to expand or move your practice, having a checklist of desirable criteria can help you stay on track. As The Lease Coach, we appreciate and applaud tenants who provide a detailed checklist of what they are looking for in each location. You should weigh many demographic aspects when considering leasing a location in a certain area or territory. Just because you’ve found a new property with space for lease doesn’t mean the demographics will fit your ideal criteria. As a chiropractic tenant, the following points will be specifically important to you when searching:
Preleasing Undeveloped Property – For Chiropractic Tenants
August 17th, 2017 - Jeff Grandfield and Dale Willerton – The Lease Coach
As either a new or existing chiropractic tenant, you may be tempted to prelease undeveloped property (to open a new practice or move your practice to). As we explain in our book, Negotiating Commercial Leases & Renewals FOR DUMMIES, this is potentially the most unpredictable lease agreement for a tenant ...
Negotiating Free Rent – For Chiropractic Tenants
August 16th, 2017 - Jeff Grandfield and Dale Willerton – The Lease Coach
Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many chiropractic tenants confuse this with ...
Negotiating the Rental Rate – For Chiropractic Tenants
August 16th, 2017 - Jeff Grandfield and Dale Willerton – The Lease Coach
As we explain in our new book, Negotiating Commercial Leases & Renewals FOR DUMMIES, your rent is typically one of your major business expenses – often second only to salaries. Consider that your rental rate can also be a major factor if and when you retire and sell your practice. ...
Diagnosing, Documenting, and Coding for Radiculopathy
June 30th, 2017 - Evan Gwilliam, DC, MBA, BS, CPC, CCPC, CPC-I, CPMA, NCICS, MCS-P, QCC, CMHP
Radiculopathy can be an unpleasant condition, but diagnosing, documenting and coding for it does not have to be. It just takes a little research. The brain communicates with the body via the spinal cord which is protected by the bones of the spinal column, called vertebrae. Nerve roots exit in ...
The One-Minute Spinal Outcome Measure
May 5th, 2017 - Ron Feise, DC
Patient-reported outcome measures are increasingly necessary elements of good clinical practice. By using a clinically meaningful outcome measure at the initial assessment and measuring change over time, you can track shifts in patient progress and thereby improve clinical decisions. Documenting treatment necessity (which can improve and facilitate reimbursement and decrease ...
National Association of Chiropractic Attorneys (NACA) Directory
March 29th, 2017 -
National Association of Chiropractic Attorneys (NACA) Directory Listed by state
Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook
March 29th, 2017 - Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...
Look Before You Leap
August 3rd, 2016 - ChiroCode
The 2016 ChiroCode Deskbook includes policies from the American Chiropractic Association regarding the difference in healthcare discount programs. It can help you select the right healthcare discount program specific to your needs! Not all healthcare discount programs are the same. The Federal Trade Commission (FTC) is warning consumers to carefully evaluate these programs. ...
Financial Hardship Policy
August 3rd, 2016 - ChiroCode
The 2016 Chirocode Deskbook offers advice on waivers! It is improper and illegal to waive co-payments and/or deductibles. For this reason, if you wish to offer some sort of assistance to a patient, the proper way to do so is through an official “Financial Hardship Policy”. Caution is advised when implementing hardship waivers. ...

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