Wiki New to Chiropractic

Create Wiki
K

kristinethms

New
Messages
3
Location
Garden City, ID
Best answers
0
Hi I need some help I took a client yesterday with over 50 denied chiropractic
claims from medicare...He used code 98942 medicare denied for co-50 they seem to be saying they were not necessary. He tells me this is the code a billing co told him to use. I need some personal help if anyone is willing, thanks
 
Hi, Yes you would need modifier AT if the visit is for acute treatment and if it's ICD10 related, the covered diagnosis ranges are M99.01-M99.05
 
Hi, a couple issues: first, the 98942 requires diagnosis codes for all 5 spinal regions since using the code signifies that all 5 spinal regions were adjusted. Second, this in turn means that documentation must show/support the 5 spinal regions that were adjusted as well as that a problem was found in each of those spinal regions. Third, the use of the -AT modifier as mentioned above is absolutely correct. The ABN form would be used if the provider feels, or deems the service to be non-covered or not medically necessary, in which case a -GA modifier would be used in place of the -AT.
My final comment is about making sure you are using approved ICD10 diagnosis codes. An example of where things get muddy, is like for us in Florida where First Coast prefers to dance to the beat of their own drum and use a specific set of diagnosis codes that are not in line with the rest of civilized society (we can't use subluxation codes as primary diagnoses). So, make sure you're not getting denials for invalid codes.
Hope this helps,
Dr Art
 
I work for a Chiropractor. For adjustments, we use 98940-AT. My medicare patients, get reimbursed with that code. I've been using this code for over 5 years. Hope that helps. Also, your primary DX codes need to be in the M99.01-M99.09 range.
 
Last edited:
Answers

The reason some denials occur comes down to definitions. Chiropractors refer to a subluxation as a misalignment of a vertebrae in relation to the one above it and below it resulting in a dysfunction. However, allopathically a subluxation is a dislocation. So, the only appropriate codes are the segmental dysfunction codes M99.01-M99.05. A word of advice about code 98942. Make sure the provider proves the existence of segmental dysfunction in all 5 region in his documentation by using the PART exam or xrays. Over utilization of this code will trigger audits.
 
medicare

kristinethms said:
Hi I need some help I took a client yesterday with over 50 denied chiropractic
claims from medicare...He used code 98942 medicare denied for co-50 they seem to be saying they were not necessary. He tells me this is the code a billing co told him to use. I need some personal help if anyone is willing, thanks
Click to expand...

yes medicare only pays for spinal manipulation. each insurance company is different on coverage. best way is to call or look up benefits of the insurance to see what is covered and allowed.
 
MODIFIER at

This is from Palmetto
check this out http://www.palmettogba.com/palmetto...ic~Modifier Lookup~8EELAH4851?open&navmenu=||


HCPCS Modifier AT

Bookmark Email Print Font - Font +
share share share



Description:
Acute treatment (chiropractic)

Guidelines/Instructions:
This modifier is submitted with chiropractic treatment codes when the chiropractor furnishes acute treatment. •This modifier may only be submitted with CPT codes 98940, 98941 and 98942. CPT code 98943 is not reimbursed by Medicare.
•Documentation in the patient's medical record must support the active nature of the treatment when this modifier is submitted
•Chiropractors must submit HCPCS modifier AT on a claim when providing active/corrective treatment to treat acute or chronic subluxation
•HCPCS modifier AT may not be submitted with services that meet the definition of maintenance therapy. Maintenance therapy includes services that seek to prevent disease and promote health, as well as prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
In order for chiropractic treatment to be covered by Medicare, the following conditions must be met: •The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment
•The manipulative services must have a direct therapeutic relationship to the patient's condition
•The manipulative services must provide reasonable expectation of recovery or improvement of function
•The patient must have a subluxation of the spine demonstrated by X-ray or physical exam
•HCPCS Modifier AT should not be submitted, on the same detail line, with Modifier GA. ◦Effective for dates of service on and after November 1, 2015, if these modifiers are submitted, on the same detail line, the service will be rejected. Rejected claims must be resubmitted as new claims.

Reference: •CMS Pub. 100-02, Chapter 15, Sections 30.5 and 240 external link (PDF, 1.27 MB
 
You must log in or register to reply here.
Top