Chiropractic Coding & Compliance Alert
Use Modifier 25 for Distinct Services
PDF
Question: The DC evaluates a new patient and performs chiropractic manipulative treatment in the same visit. Is there any modifier that we should be using to get paid for both the evaluation and the treatment?
North Dakota Subscriber
Answer: Turn to modifier 25 (Significant, separately identifiable evaluation and management service performed by the same provider on the same day as a procedure or other service). This modifier, when used on established or new patient evaluations, implies that the evaluation was above and beyond the usual pre-service work component of the associated manipulative procedure.
Carriers may not pay for exams without the -25 modifier when a manipulation code is also billed for the same date of service. Exams billed without the modifier-but with a manipulation on the same date of service may be denied. Please ensure that you report the -25 modifier so that you do not face payment issues and delays.
Related Articles
Chiropractic Coding & Compliance Alert
- Compliance/Reimbursement:
Take Aim at Modifiers and Myths of Advanced Beneficiary Notices
Solve your ABN dilemmas with these 4 tips. Are you one amongst those who often [...] - Auditing:
Brace Yourself as Noridian Medicare Proposes to Audit 98941 Claims
Use these strategies to wade through tough payer scrutiny If you’ve noticed an increase in [...] - ICD-10 Update:
Tune in Your Radar to This CMS Advice
Heed these 12 facts that CMS wants you to know about ICD-10. The clock is [...] - You Be the Coder:
Can We Code Massage with 97112?
Question: We usually submit 97124 for massage, but we were told to use 97112 instead. Is [...] - Reader Questions:
Determining Which Payer Provides for Co-payment
Question: When we have a patient with both a primary and a secondary insurance, which one [...] - Reader Questions:
Where to Look for LCDs for ICD-10
Question: Where can we find the Medicare LCDs for ICD-10? Iowa Subscriber Answer: Medicare contractors have already [...] - Reader Questions:
Use Modifier 25 for Distinct Services
Question: The DC evaluates a new patient and performs chiropractic manipulative treatment in the same visit. [...] - Reader Questions:
When Patient Doesn't Understand ABN
Question: We have a patient who was put under maintenance therapy. She was given an ABN [...]