Forum - Questions & Answers

Nov 17th, 2021 - phil.jen 2 

Two adjustment codes

When billing two adjustment codes on the same visit day (like 98940 and 98943) is there a modifier or a way to get both adjustment codes paid? 

Nov 18th, 2021 - ChrisW   256  1 


98943 is not covered by Medicare, so if your payer(s) follow Medicare guidelines, it is unlikely they will pay for this either.  98943 has a Medicare Physician Fee Schedule indicator (MPFS) status code of “N - Non-covered Service: These services are not covered by Medicare.”
In addition, if you know a procedure is non-covered you should use the appropriate modifiers;
GA modifier to indicate that you expect Medicare to deny the service, this is stating you have an Advance Beneficiary Notice (ABN) signed by the beneficiary if there is no ABN you should use the
GZ modifier indicating you expect Medicare to deny the service, but you do not have an ABN on file signed by the beneficiary.
A commonly used modifier when coding subluxation is the Modifier AT- Acute treatment is used for CPT codes 98940, 98941, and 98942 if providing active/corrective treatment to treat acute or chronic subluxation. This is not used in addition or to get claims paid just to indicate “Acute Treatment”. 

Nov 19th, 2021 - phil.jen 2 


  If it's for a different insurance, though, like highmark or UPMC and the chiropractor has marked 98940 and there a modifier for that?   Thank you for your response.

Nov 22nd, 2021 - ChrisW   256  1 


If the codes are payable, I would suggest Modifier "59 - Distinct Procedural Service". Modifier 59 should be used only if there are no other applicable modifiers and it is appropriate. 

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