Chiropractic Coding & Compliance Alert

Published on Fri Feb 13, 2015 PDF

Question: How do I report other diagnoses associated with the primary diagnosis of subluxation in the Item 21 of the CMS 1500 form?

Mississippi Subscriber

Answer: For chiropractic claims, use an ICD-9-CM code in the 739 (Nonallopathic lesions not elsewhere classified) series specifying subluxation for the primary diagnosis. Include a secondary ICD-9-CM for the symptoms associated with the diagnosis of subluxation, which can be found in the local coverage determination (LCD) of your Medicare contractor. You can use up to four ICD-9-CM codes.

Although Item 21 can only contain the diagnoses for two regions treated and its corresponding symptoms, the clinical record MUST document the additional primary and secondary diagnoses justifying treatment of the additional regions billed.

Remember: The new claim form allows for up to 12 Dx codes.