Posts tagged documentation
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Billing Medicare can be confusing for a new chiropractor and sometimes for an established chiropractor.
Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation (i.e., by use of hands) of the spine for the purpose of correcting a subluxation. For the purpose of Medicare Chiropractic codes, a subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered, although contact between the joint surfaces remain intact. The patient must have a subluxation of the spine as demonstrated by x-ray or physical examination.
Keep in mind that x-rays are considered noncovered when billed by the chiropractor. No other diagnostic or therapeutic services furnished by a chiropractor or under his or her order is covered. This means if a chiropractor orders, takes or interprets x-rays or any other diagnostic test, the x-ray or diagnostic test can be used for claims processing purposes, but Medicare coverage and payment are not available for these services.
ICD-9-CM Codes that Support Medical Necessity
The CPT/HCPCS codes included in this policy will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as “not medically necessary.”
Medicare is establishing the following limited coverage for CPT/HCPCS codes 98940, 98941 and 98942:
Primary Diagnosis Codes
Covered for:
739.0-739.5
Non-allopathic lesions, not elsewhere classified
Secondary Diagnosis Codes
Group A Diagnoses
Covered for:
307.81
Tension headache
719.48
Pain in joint, other specified sites
Note:
When using this code, you must specify spine.
723.1
Cervicalgia
724.1-724.2
Other and unspecified disorders of back
724.5
Backache, unspecified
724.8
Other symptoms referable to back
728.85
Spasm of muscle
784.0
Headache
Group B Diagnoses
Covered for:
720.1
Spinal enthesopathy
721.0 - 721.2
Spondylosis and allied disorders (arthritis, osteoarthritis, spondyloarthritis)
724.79
Disorders of coccyx, coccygodynia
729.1
Myalgia and myositis, unspecified
729.4
Fasciitis, unspecified
846.0
Sprains and strains of sacroiliac region, lumbosacral (joint)(ligament)
846.1 - 846.3
Sprains and strains of sacroiliac region
846.8
Sprains and strains of sacroiliac region, other specified sites of sacroiliac region
847.0 - 847.4
Sprains and strains of other and unspecified parts of back
Group C Diagnoses
Covered for:
353.0-353.4
Nerve root and plexus disorders
353.8
Other nerve root and plexus disorders
722.91-722.93
Other and unspecified disc disorder
723.0
Spinal stenosis in cervical region
723.2-723.5
Other disorders of cervical region
Group D Diagnoses
Covered for:
721.3
Lumbosacral spondylosis without myelopathy
721.41 - 721.42
Lumbosacral spondylosis with myelopathy
721.7
Traumatic spondylopathy
722.0
Displacement of cervical intervertebral disc without myelopathy
722.10-722.11
Displacement of thoracic or lumbar intervertebral disc without myelopathy
722.4
Degeneration of cervical intervertebral disc
722.51-722.52
Degeneration of thoracic or lumbar intervertebral disc
722.81-722.83
Postlaminectomy syndrome
724.01-724.02
Spinal stenosis, other than cervical
724.3
Sciatica
724.4
Thoracic or lumbosacral neuritis or radiculitis, unspecified
724.6
Disorders of sacrum, ankylosis
738.4
Acquired spondylolisthesis
756.11 - 756.12
Anomalies of spine
839.01 - 839.08
Other, multiple and ill-defined dislocations, cervical vertebra,
839.20 - 839.21
Other, multiple and ill-defined dislocations, thoracic and lumbar vertebra, closed
839.41 - 839.42
Other, multiple and ill-defined dislocations, other vertebra, closed
953.0 - 953.4
Injury to nerve roots and spinal plexus
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Documentation Requirements
Documentation supporting the medical necessity of the service should be legible, maintained in the patient’s medical record, and must be made available to Medicare upon request.
Please see Medicare Benefit Manual sections referenced above for national documentation requirements for Medicare payment of chiropractic services.
Utilization Guidelines
Medicare does not expect that substantially more than the following numbers of treatments will usually be required:
12 chiropractic manipulation treatments for Group A diagnoses.
18 chiropractic manipulation treatments for Group B diagnoses.
24 chiropractic manipulation treatments for Group C diagnoses.
30 chiropractic manipulation treatments for Group D diagnoses.
Claims for chiropractic services that exceed the numbers above may be subjected to complex manual medical review either prior to payment or as part of a post-pay Medicare audit.
The AT modifier must be used when a patient is being treated for an acute treatment. If you do not use the AT modifier, the services will be considered maintenance and will therefore be denied.
QuickSOAPnotes from www.chiroconceptions.com makes documenting a Medicare visit easy and fast.
