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Credentials for billing 99xxx

  1. #1
    White Plains, NY
    Default Credentials for billing 99xxx
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    I have been struggling with a Chiro who insists he can bill 99xxx E&M codes. Since he's apparently found a payer whose edits didn't bounce his claims, now he's convinced other NPPs, specifically nutritionists that they, too can bill 99xxx. I have looked at CMS, and I can't find documentation to SHOW them they are in error.
    Anybody have any? CPT book? AMA site? CMS? Ingenix? Perhaps something that talks about credentialing? I found LSW and PT and OT and ST on CMS. I know E&M is outside their scope of practice - but I do want some other source to cite besides me!


  2. #2
    North Carolina

  3. #3
    Well, chiropractors can bill E/M, Medicare, Medicaid, Tricare, etc won't pay for them though. Most commercial carriers will, depending on the chiropractic benefits covered in the patients plan.

    This is what I come up with. I would make them prove to you they can bill those. What is their scope of practice?

    If all else fails, send in a test claim under the their provider#. Just be sure you don't bill the patient when they reject it.

    Laura, CPC, CEMC

  4. #4
    White Plains, NY
    Default Credentials
    These were both very helpful!
    Never saw it put so clearly about Chiros before, and the Meta-analysis RE MNT was really interesting.
    Much obliges, y'all!


  5. #5
    Default Chiro E&M
    According to AMA and CPT guidelines and manuals, there are only 4 true Chiropractic codes 98940, 98941, 98942, and 98943. The rest are hidden away in different areas of these manuals. Codes such as your Evaluation and Management codes (9920X-9921X), Diagnostics (7000 codes) and Physical Therapy (9000 codes) are also available to most chiropractors. (Be sure to check with your state board to determine your scope of practice.)

    The ability to use E&M will vary from state to state and from commercial carrier and commercial contracts. If the chiropractor is paid for the E&M code, it may have been an error on the part of the payor and no one should be surprised when a recoupment is done as far as 3 years after the payment has been made.

    Chiropractors should always confer with their local licensing board regarding their scope of practice and document what they have been told to support their use of the 99xxx E&M code.

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