Chiropractic - Articles

ICD-10-CM 2023 Code Changes for Chiropractic
October 6th, 2022 - Wyn Staheli
There were several changes to the ICD-10-CM codeset for 2023 which went into effect October 1, 2023 and could impact chiropractic. At the time of publication, it was unknown how payers would respond to these changes. This article only discusses some of the changes to the ICD-10-CM codes. Changes to procedure codes such as “Prolonged Services” for office E/M visits are included in the 2023 ChiroCode DeskBook.
Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities
July 13th, 2022 - Dr. Evan M. Gwilliam, DC, MBA, QCC, CPC, CCPC, CPMA, CPCO, AAPC Fellow, Clinical Director
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

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Stay out of Trouble — Understand the Qualified Medicare Beneficiary (QMB) Program
October 7th, 2020 - Wyn Staheli, Director of Research
To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.
ICD-10-CM 2021 Coding Updates for Chiropractic
September 29th, 2020 - Wyn Staheli, Director of Research
October 1st is just around the corner and that means it’s time for updates to the ICD-10-CM code set. This year there are some interesting changes such as a new headache type, new codes related to TMJ, several new codes for reporting accidents involving micro-mobility devices (e.g., hoverboard), and some other changes.
Not Following the Rules Costs Chiropractor $5 Million
September 1st, 2020 - Wyn Staheli, Director of Research
Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake?
Watch for Payer Telehealth Coverage Changes
June 3rd, 2020 - Wyn Staheli, Director of Research
As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
Getting Your Practice Back on Track
May 12th, 2020 - Wyn Staheli, Director of Research
As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement.
More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About
April 7th, 2020 - Wyn Staheli, Director of Research
On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar.
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
March 31st, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly.  Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
COVID-19 Chiropractic Resources
March 31st, 2020 - Wyn Staheli, Director of Research
COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.
COVID-19: Cybercrime, Telehealth, and Coding
March 25th, 2020 - Wyn Staheli, Director of Research
Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...
Q/A: Did Noridian Stop Covering the M99.0- Codes?
February 19th, 2020 - Wyn Staheli, Director of Research
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
Medicare Begins Covering Acupuncture Services
February 19th, 2020 - Wyn Staheli, Director of Research
Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules.
Inadequate Exclusion Screenings Could Put Your Practice at Risk
January 21st, 2020 - Wyn Staheli, Director of Research
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Q/A: Can I Order a TENS unit for a Medicare Patient?
December 3rd, 2019 - Wyn Staheli, Director of Research
Question Can a chiropractor order a TENS unit for a Medicare patient? We cannot order X-rays for a Medicare patient so I assume we cannot order a TENS unit either. Answer It’s not that you can’t order the TENS unit, it’s just that when it comes to doctors of chiropractic, Medicare only covers ...
Answering the Question: Does my Insurance Cover Chiropractic Care?
December 3rd, 2019 - Wyn Staheli, Director of Research
The question "Does my insurance cover chiropractic care" is the ongoing question chiropractic offices have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer so there isn't one easy answer.
Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
November 19th, 2019 - Wyn Staheli, Director of Research
Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
Q/A: How Do I Bill a House Call?
September 30th, 2019 - Wyn Staheli, Director of Research
Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form? A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...
New Codes for Dry Needling
September 30th, 2019 - Wyn Staheli, Director of Research
Find out what you need to know about the new codes for dry needling, also known as trigger point acupuncture.
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
Attention Chiropractors!
August 20th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Find-A-Code has created a TOPIC page specifically for Chiropractors. Check it out! We have simplified your search with Articles, Tips, Webinars, and Tools all in one place for your convenience. Be sure to visit us today. Simply go to Findacode.com then hover over TOPICS at the top of the page, then select Chiropractic. ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
August 13th, 2019 - Wyn Staheli, Director of Research
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
Q/A: What if my Patient Refuses to Fill out the Outcome Assessment Questionnaire?
August 6th, 2019 - ChiroCode
Question: What if my Medicare patient refuses to fill out the outcome assessment questionnaire? Answer: Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...
Q/A: How do I Bill Mobile Clinic Services?
July 29th, 2019 - Evan Gwilliam DC, MBA, BS, CPC, CCPC, CPC-I, QCC, MCS-P, CPMA, CMHP, AAPC Fellow
Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?
The Role of Chiropractic in Value Based Payment Systems
July 29th, 2019 - Wyn Staheli, Director of Research
Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition.
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
July 17th, 2019 - Wyn Staheli, Director of Research
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
July 15th, 2019 - Wyn Staheli, Director of Research
Question: It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
July 8th, 2019 - Wyn Staheli, Director of Research
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following: Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?
July 8th, 2019 - Wyn Staheli, Director of Research
Question: Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services? Answer: While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ...
Rules for Rendering Unproven, Investigational or Experimental Procedures
July 1st, 2019 - Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA
If you haven’t reviewed your state guidelines or taken a recent look at third-party payer policies on unproven, investigational or experimental procedures, now is the perfect time to make sure you’re up to speed with this important information. Most providers are surprised to see commonly used devices or techniques listed ...
Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?
June 25th, 2019 - Wyn Staheli, Director of Research
Question: Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident? Answer: There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ...
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
May 29th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
Your New Patient Exam Code Could Determine How Many Visits You Get
May 27th, 2019 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ...
Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?
May 27th, 2019 - Wyn Staheli, Director of Research
Question Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3. Also, it shows the ...
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
April 29th, 2019 - Wyn Staheli, Director of Research
Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942? Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...
Q/A: What’s Wrong with the Diagnoses on my Claim?
April 22nd, 2019 - Wyn Staheli, Director of Content
Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
Auditing Chiropractic Services
April 22nd, 2019 - By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
Corrections and Updates
April 1st, 2019 - Wyn Staheli, Director of Research
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics. Published Articles We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...
Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?
April 1st, 2019 - Wyn Staheli, Director of Research
I submitted a claim to the VA and it’s being denied. Why? There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...
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 ...
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 ...
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.
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: 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?
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?
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: 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?
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 ...
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: ...
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 ...
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 ...
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 ...
National Association of Chiropractic Attorneys (NACA) Directory
March 29th, 2017 -
National Association of Chiropractic Attorneys (NACA) Directory Listed by state
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. ...
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. ...

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