December 27, 2018 by Dana Lingard Article Insurance, Billing, Coding
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Chiropractic CPT Codes – Current Procedural Terminology or CPT Codes are intended to provide consistent information about a patient’s condition for procedures, medical services and healthcare billing. Learn more!

Chiropractic CPT Codes

The American Medical Association (AMA) maintains CPT codes via its CPT Editorial Panel. CPT codes are used to describe all medical procedures a provider performs on a patient. The CPT code informs the insurance company that the provider wants reimbursement for these procedures. Each CPT code contains five characters, which are numeric or alphanumeric, based on CPT code category. While there are three categories of CPT codes, most chiropractic providers primarily use Category I codes, which correspond to specific services or procedures. There are also two character modifiers attached to certain codes used to clarify any descriptions.

Where Can I Find Chiropractic CPT Codes?

The AMA releases updated versions of CPT codes each October. Codes, even common ones, may change from year to year. Providers receive notification that such codes are scheduled to change in advance. Service providers must pay licensing fees to obtain code access.

Chiropractic CPT Code Lookup

Once the provider completes a license request form with the AMA, you can order a CPT code data file for that year. Install the date file annually and a CPT code lookup is simple.

The Most Common Types of Chiropractic CPT Codes

Unlike other types of medical practices, chiropractors use relatively few CPT codes. There are only four codes for chiropractic manipulative treatment. Theses codes are based on the spinal regions treated:

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions
  • CPT Code 98943 Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions (Not Covered by Medicare)

The documentation for these CPT billing codes must include the proper number of spinal regions per code.

Another list of CPT codes commonly used includes:

  • CPT Code 99203 – Initial Exam
  • CPT Codes 99202-99204 – Evaluation and Management, Initial Visit
  • CPT Code 99212-99214 – Evaluation and Management, Established Patient
  • CPT Code 97140 – Manual Therapy
  • CPT Code 97110 – Therapeutic Exercise
  • CPT Code 97750 – Physical Performance Examination
  • CPT Code 99211 – Reevaluation
  • CPT Code 97112 – Neuromuscular Re-education
  • CPT Code 97530 – Therapeutic Activities
  • CPT Code 97010 – Hot/Cold Packs
  • CPT Code 97014 – Electrical Stimulation (Unattended)
  • CPT Code G0283 – Electrical Stimulation, Medicare Non-Wound (Unattended)
  • CPT Code 97035 – Ultrasound/Phonophoresis
  • CPT Code 97161 – PT Evaluation: Low Complexity
  • CPT Code 97116 – Gait Training
  • CPT Code 97162 – PT Evaluation: Moderate Complexity
  • CPT Code 97535 – Self Care/Home Management Training
  • CPT Code 97016 – Vasopneumatic Device
  • CPT Code 97032 – Electrical Stimulation (Manual)
  • CPT Code 97012 – Mechanical Traction
  • CPT Code 97164 – PT Re-Evaluation
  • CPT Code 97113 – Aquatic Exercise
  • CPT Code 97150 – Group Therapy
  • CPT Code 97124 – Massage
  • CPT Code 97018 – Paraffin Bath
  • CPT Code NC001 – No Charges This Visit
  • CPT Code 97163 – PT Evaluation: High Complexity
  • CPT Code 97022 – Whirlpool
  • CPT Code 97033 – Iontophoresis
  • CPT Code 97039 – Laser/Other
  • CPT Code 97026 – Infrared Light

Along with CPT codes, you must familiarize yourself with the modifiers used to explain how and why the procedures were performed. The correct use of modifiers can mean the difference between a claim’s acceptance and denial. For example, KX is a Medicare PT Cap Auto Exception, and without including this modifier it’s almost certain the insurer would reject the claim.

What Happens If I Use the Wrong Chiropractic CPT Code?

If you enter the wrong CPT code, the claim is rejected. The insurance company cannot pay the bill the way it was received due to error. The claim is sent back to the provider, with an explanation of why it was rejected. You then have the opportunity to correct the CPT code and resubmit the claim. Of course, the process of rectifying the error delays payment.

A denied claim differs from a rejected claim. The insurer determines that the claim is not payable. These claims are also returned, with an explanation for the denial. There is an appeals process for denied claims. The process, however, is time consuming.

The most common errors made regarding CPT codes include using the wrong code and omitting a code altogether. Another frequent error is using an International Classification of Diseases (ICD) code in place of a CPT code or vice versa. Using incorrect or conflicting modifiers are further common mistakes. Human error may add an extra number or omit a digit with the CPT code, rendering it undecipherable.

Chiropractic CPT Code Tips

There are codes that may present billing problems for your practice. Such codes may prove more of an issue with some insurance companies than with others. Make a list of such CPT codes, and the insurance companies that most often show these issues. Checking this list will help you know that you may need to provide additional documentation or more coding training for your employees. For example, many providers report problems with one major insurance company regarding CPT Code 97140, manual therapy. Basically, the insurer won’t pay for manual therapy and a chiropractic adjustment performed on the same day. The key is that the manual therapy and chiropractic adjustment cannot be made on the same anatomical area on the same visit, so make sure your documentation is thorough and that the time for manual therapy is indicated with a time code.

Then there’s Medicare. According to a 2014 Comprehensive Testing Error Program (CERT) study measuring incorrect Medicare fee for service payments, there was a 54 percent error rate in chiropractic claims. The majority of errors were due to insufficient documentation or related documentation problems, according to the Centers for Medicare and Medicaid Services (CMS). Medicare chiropractic coverage is limited to manual manipulation of the spine for subluxation correction. The three codes for Medicare are 98941 through 98943. While a chiropractor may use a manual device on a Medicare patient in conjunction with using manual manipulation, Medicare won’t pay for it. When submitting a claim for manipulation, you must use the Acute Treatment (AT) modifier.

What you never want to do is provide auditors with reasons to examine billing practices. Unfortunately, CPT code errors can do just that. To minimize the odds of triggering an audit, make sure provider’s notes are included. These notes should include the indication for treatment, treatment goals regarding manual therapy, objective measures for patient progress, the patient’s progression and the treatment plan. The latter should include duration and frequency. When Medicare is involved, make sure all services meet Medicare’s coverage requirements and all documentation is full and complete.

Here’s another important tip: If you don’t know coding yet, study it. Coding has a language, and once you master it, you will have a better grasp of your claims practices plus you can communicate more effectively with insurance reviewers and payers.

How ChiroTouch Can Help with Billing Codes

ChiroTouch’s chiropractic billing software makes it easy to add CPT codes. Through our integrated system, billers can link charge codes directly from the provider’s SOAP note macros, preventing the use of erroneous codes. If you do experience issues, our support team is available 24/7 to help sort out the problem. Contact ChiroTouch today and find out how our chiropractic billing software can streamline your practice’s billing process.

 

Sources:

https://www.aapc.com/blog/27688-for-chiropractors-know-97140-billing-rules/

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/c/chiropractic-services-mapg.pdf

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/34585_31/Billing_and_Coding_Guidelines_L34585.pdf

https://acomhealth.com/chiropractic-billing-guide-2018/

https://www.aapc.com/blog/43045-tips-for-chiropractic-evaluation-and-management-coding/

https://acomhealth.com/chiropractic-billing-patterns-auditor-red-flags-part-1/

http://www.codingahead.com/2011/11/cpt-codes-for-chiropractic-services.html

https://www.webpt.com/cpt-codes

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1601.pdf

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