Question Medicare and Chiropractic Billing

mhefner5

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Middleton, ID
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All right coding friends, I need some SERIOUS input for billing Medicare for Chiro services (Idaho). I'm on my last nerve with this insurance company. I have a date of first treatment. My 98940-98941 are billed with the -AT modifier and dx codes M99.11-M99.13. My most recent denial from these peoples is CO-50. Not medically necessary. Now keep in mind, when I took on this client, he had months and months of back billings from 2018-current, and most of these patients come in 2-3 times per week. Any information given would be greatly appreciated, because at this point, I'm at a loss. HELP PLEASE :(
 

thescientist8

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All right coding friends, I need some SERIOUS input for billing Medicare for Chiro services (Idaho). I'm on my last nerve with this insurance company. I have a date of first treatment. My 98940-98941 are billed with the -AT modifier and dx codes M99.11-M99.13. My most recent denial from these peoples is CO-50. Not medically necessary. Now keep in mind, when I took on this client, he had months and months of back billings from 2018-current, and most of these patients come in 2-3 times per week. Any information given would be greatly appreciated, because at this point, I'm at a loss. HELP PLEASE :(
Was there a secondary DX (medical code) submitted?
 

mhefner5

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Middleton, ID
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Just the areas that were treated. I didn't use pain codes ie: M54.2, M54.5, M54.6. So if this is the problem, I can go back and fix all of these.
 

lconley

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Can there be more than 1 incident per patient? ie. treating the thoracic region and also treating the cervical region? Or do I need to end one incident before starting another?
 

thescientist8

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Can there be more than 1 incident per patient? ie. treating the thoracic region and also treating the cervical region? Or do I need to end one incident before starting another?
I apologize for the late response. I didn't get an alert on this one. Anyway, yes, I'd add codes. M54.2, M54.5. M54.6, these are all under Category I and support medical necessity. Keep subluxation as primary DX, then add sec codes.
 

pattiland

Networker
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I'm a little confused- does your LCD ask for M99.01, .02, .03, etc? Typically with Medicare these are the first listed codes followed by a diagnosis code for each sublux. Example: a 98940 might have a diagnosis of M99.03 M53.2X7 M99.01 M54.2

Your LCD will have all of the instructions for what sublux codes and diagnosis codes are approved for Medicare. The LCD will also include advice about documentation.

And if you still need help, see if you have state chiropractic association in Idaho. They have websites with good advice that is usually easier to digest than what's found on CMS/Medicare sites.

Good Luck!
 

erjones147

Expert
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I had to go through a bit of wrangling with Novitas to get it down....

Use an M99.0x code as primary and make sure there is a pain code somewhere as a secondary diagnosis

As a Novitas CS rep explained to me, how can it be mod -AT if the patient isn't in any pain?

Novitas' LCD is pretty thorough when it comes to which codes must be used for primary and which have to be present for secondary
 
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