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Jo-Anne Q Chiropractic versus Medical CodingI recently switched from coding & billing with a 975 collection rate to billing fora chiropractic group Now 50 of my claims are being denied - particularlywith Medicare and Im not doing anything differently than I did at my prior job A Chiropractic billing is very very differentthan medical billing for a physician and the most important task at hand is to researcheach payer rule for chiropractic and that goes for other specialties too like podiatryand so forth There are limitations with some specialties Coding should not be an issue with this specialtybut knowledge of the guidelines is imperative Many health insurance plans do not offer chiropracticbenefits and other plans offer this as an additional coverage for a fee for patientsbut please note that anyone on Medicare Medicare has stringent guidelines and offers minimalcoverage for services provided What does Medicare pay for Chiropractic care has limited coverage Medicare covers manipulations only of thespine if medically necessary to correct a subluxation Office visits are not covered X-Rays are not covered Manipulation of extremities hands and feetare not covered A subluxation which is an incomplete or partialdislocation of the vertebrae must be the primary diagnosis always followed by a secondary neuromusculoskeletalcondition The subluxation must be demonstrated in thepatient documentation in the event of an audit and it by either an x-ray or a physicalexam and the specific vertebrae must be documented Chiropractic manipulation codes must be appendedwith a modifier AT to indicate the care is active or corrective Omission of this modifier will result in anautomatic denial with no patient responsibility Thats very important but again this isMedicare and if youre not using that modifier or youre billing for an office visit likeyou would for a doctor or medical doctor thats why your collections are so poorbecause its just very specific rules On the CMS-1500 Form block 14 must have adate and not necessarily a date of injury or first symptom but the date of the firstvisit for the current episode If the patient just came in that day to starther treatments that would be the date of service Block 19 must indicate an x-ray date if therewas an x-ray taken and used to identify the subluxation There were only three codes that Medicareaccepts for billing and thats the 98940 which is 1-2 regions 98941 3-4 regions ofthe spine and 98942 for 5 regions of the spine If you look in the CPT manual youll actuallysee a 98943 for extremities because Im talking about Medicare those are the onlythree that are accepted As far as Advanced Beneficiary Notices allother services the chiropractic with Medicare such as exams x-rays therapies are not statutorilycovered services when performed by a chiropractor so therefore youre not required to giveyour patients an ABN to sign If a doctor a chiropractic who gives outan ABN is strictly voluntary and all the rules are chiropractic...