Forum - Questions & Answers

Jul 8th, 2020 - Coder132 2 

99201, 99211 coding

Hi,
I am seeking information regarding CPT coding for a chiropractic office.

The care I provide often requires that we do an office visit on an established patient for wellness which results in us not needing to provide an adjustment. The code that I believe best describes this would be 99211 but the visit is for wellness and maintenance, not for medically necessary care. What would be the correct modifier to put at the end of that code for our records? GA, GY or some other modifier? Is there any other code that better fits this description? (This is not for a Medicare patient)
What would be the best code for a new patient on an initial visit, where no adjustment was given? 99201 with a modifier?
I do not want to be reimbursed for these codes, just want for my records.

Thank you!

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Jul 14th, 2020 - ChrisW   182  1 

re: 99201, 99211 coding

If you did any type of preventative adjustment not considered active or restorative, you would report S8990 for Non-Medicare plans. S8990 is used for maintenance and wellness care that is elective and not therapeutically necessary but used to promote health and enhance the quality of life. If it for your records only, this would be fine, and if not billed to a provider the modifier would not be necessary.

However, the use of the GY modifier is indicating the service is statutorily excluded and can be used for any non-Medicare insurers. If you use an E&M code you need to ensure you are meeting every component of the code such as the different levels and review of systems.

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Aug 25th, 2020 - Coder132 2 

re: 99201, 99211 coding

Thank you for your reply. Yes this is just for my records, My office does not bill insurance.

Just to clarify, if I do an exam to determine if they do or don't need an adjustment on this visit i.e palpation, range of motion etc, and the patient does not require an adjustment that day, I should put down s8990 since it isn't for active or restoration care? Would that be the most appropriate code or is there a better code that should be used?

Thank You!

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Aug 25th, 2020 - Coder132 2 

re: 99201, 99211 coding

Thank you for your reply. Yes this is just for my records, My office does not bill insurance.

Just to clarify, if I do an exam to determine if they do or don't need an adjustment on this visit i.e palpation, range of motion etc, and the patient does not require an adjustment that day, I should put down s8990 since it isn't for active or restoration care? Would that be the most appropriate code or is there a better code that should be used?

Thank You!

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Aug 27th, 2020 - ChrisW   182  1 

re: 99201, 99211 coding

S8990 can certainly be used in this situation. when there is only maintenance for wellness care. this is not reported to insurance, but for documentation purposed showing it is elective and not therapeutically necessary you can use S8990. I hope this helps. If you were reporting this to a payer, there may be specific payer guidelines depending on the payer on how it is reported. Remember to utilize your ABN in this situation.

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