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Wiki Chiropractors & E/M coding

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Sheri Varner

Sheri Varner

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Bentonville, Arkansas
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I work in a multi-disciplinary clinic with (2) chiropractors, (1) orthopedic physician, (2) physical therapists and (1) Nurse practitioner.
I believe I know the answer to the question; however, the provider that I'm debating this with has been told that chiropractors can bill E/M codes as long as they use their NPI/TID and not the group numbers when billing.

A new patient presents to the office for a problem - Nurse practitioner bills 99203. Same day- within the same clinic (different Tax ID, different NPI) patient presents an issue to the chiropractor. Can the chiropractor bill a new patient e/m code 99203 or 99201 as well?

Thank you,

Sheri
 
Is the patient presenting to the chiropractor with a new issue or same issue (same dx code) addressed by the NP?

Will the chiropractor be performing therapeutic services on this day, if same issue (same dx)?

It's a little more complex than just same day ecounter... CMS does state providers of different specialty within the same group practice can separately bill; however, it sounds like you also need to consider Mod-25, Incident to guidelines, and New problem/same day treatment here...
 
I apologize... I should've been more clear when stating and asking my question... this pertains to more of a hypothetical type issue. Yes, the chiropractor would be performing therapeutic services same day on a different issue... different dx.
 
I'm a coder in automotive insurance. 90% of the claims I deal with are chiro related. As far as I know, the DC can bill new patient exam even if the NP did so on the same day. Different speciality and NPI # makes it ok. As a payer, we kind of grimace when we see this, but we do pay for them. Hope it helps!
 
I am not sure I agree with that statement. If the mid-level provider is using the DC to supervise (incident to guidelines) then they both can't bill. How is everything billed? I am sure under one EIN number.

I would stick to the DC providing the E&M (new patients primarily) and then subluxation codes if provided, POC established and written for the Mid-level to follow.
 
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