In the absence of payer guidance, look to CMS and CPT® for guidance on reporting an E/M as a separate service from chiropractic manipulative treatment with modifier 25. Editor’s Note: Healthcare Business Monthly was recently asked about reporting evaluation and management (E/M) services separately from chiropractic manipulative treatment (CMT) of the spine. As with most ...
In Audit
Aug 28th, 2017
“A Brooklyn Chiropractor Received Unallowable Medicare Payments for Chiropractice Services,” declares the Office of Inspector General (OIG) in an August 2017 report. According to the report, the New York chiropractor received at least $672,000 in improper payments over a two-year period. There’s a lesson to be learned here for chiropractic coders. First, Some Background Chiropractic ...
Part 1: Arm yourself with bundling rules and medical policy knowledge. Cost control and denials are common in orthopedic care. Over the next two months, we’ll review common mistakes that lead to orthopedic claims denials and provide tips to avoid those mistakes. This month, we’ll discuss unbundling and medical policies. Next month, we’ll discuss up-coding ...
Proper reimbursement requires clinical and office staff to play by the rules. By Kristy Johnston, CPC Proper documentation and reimbursement requires all staff — from the personnel in charge of authorizations, to the provider, to the coder/biller — to understand the chiropractic procedure and diagnosis codes most commonly used in the office. Adjustment Codes: 9894X Although ...
In Audit
May 1st, 2014
Use the latest OIG work plan to amp up your compliance plan and audit efforts. By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO The U.S. Department of Health & Human Services Office of Inspector General (OIG) has released its annual work plan, outlining the new and ongoing hot spots for healthcare fraud and abuse ...