Chiropractor billing out under another provider

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When is it okay for a chiropractor to bill out under another provider, such as a pain management doctor? Would the codes remain the same for the chiro, including the CPTs 98940-43.
 

SharonCollachi

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Chiro is not my area, but I found this to be a very interesting question. Billing under another provider means billing "incident to". I would think chiro would not be able to do that, because the nature of chiro services are not "of the type commonly furnished in a physician's office or clinic, and must be an integral, although incidental, part of the physician's professional services." This means if the chiro isn't there, then the MD would perform the work. My question therefore, is, would the MD actually do the work?

I found an article by a law firm in Texas that the Texas Board of Chiropractic Examiners has an enforcement case now (but I am unclear when "now" is), that did this and is charged with criminally fraudulent conduct.

There was another article by an attorney about chiropractors in trouble who did this just to get higher reimbursements, and/or performed services when the MD was not in the office (required under incident-to).
 

thomas7331

True Blue
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I don't believe that it would be compliant for a chiropractor to bill under a physician's credentials. Even if all of the 'incident to' requirements were met (which would be very difficult in this arrangement) a chiropractor is not a mid-level provider and because the training is so different from a physician's, I don't believe a physician would be qualified to supervise a chiropractor either. If your providers are serious about billing this way and insistent on it, I would recommend they speak to an attorney before moving forward.
 
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