Getting insurance either for providing medical services or receiving medical treatments can benefit both the patients and the providers simultaneously. When it comes to chiropractic medical treatment, getting medical insurance to acquire an even better level of services is better. It elevates the sense of security by knowing you are covered and receives the best care. As for chiropractor medical providers, to obtain complete reimbursement for the rendered services, ensuring the use of accurate chiropractic CPT codes is an essential step to follow.
This leads us to mention the crucial benefits of using accurate codes for chiropractic-provided services and the most common principles used for chiropractic services. Keep reading to understand them both.
Benefits of using accurate chiropractic CPT codes for insurance billing
It automatically gives you leverage from the patients’ perspective to have insured by an insurance provider. They feel secure in payments on finding a practice that is enrolled in-network. New or old clients are more inclined to work with an in-network practitioner and avoid receiving services from someone who doesn’t accept their insurance coverage. This makes them pay their bills out of pocket, and this becomes an extra hassle to follow up with the claims.
In addition, insurance acceptance in your practice expands your client base’s reliance on the provision of medical services. If you are unsure about the claims submission and preparation, don’t hesitate to contact Clinicast expert professionals to cater to your claims and ensure you get paid for the services you provided wholly and accurately.
Getting started with modifiers and CPT codes
Chiropractic CPT Codes are designed and regulated by the American Medical Association. They get updated annually with the codes and modifiers. These modifiers and updated codes deliver information about the newly evolved diseases and the treatment provided for them. Since they are maintained by AMA, insurance companies (private or federal) need to comply with the codes and guidelines to use them as a minor mistake in codes or any other compliance error can delay the reimbursement process and thus affect the practice’s revenue management cycle.
The most commonly used Chiropractic CPT Codes are categorized into three categories, whereas chiropractic biller use category I to bill and describe chiropractic services for in and outpatient billing.
These CPT codes define the measure of the services provided and the equipment, but to define them in certain cases, billers need to use modifiers to explain them further to the insurance providers. If a used modifier doesn’t satisfy the reason for its usage or a biller fails to use a modifier that translates the meaning of the provided services, the claim will be rejected, and the practice needs to resubmit the claim ensuring that the required changes have been made.
Here are the two most commonly used CPT codes for chiropractic treatment;
- 25: “significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service”
- 59: “A procedure or service was distinct or independent from other non-E/M services performed on the same day”
List of chiropractic CPT codes
- CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
- CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
- CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
- CPT Code 98943 Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions
- CPT codes for Treatment and appointment types
CPT Code 99202 – Evaluation and Management, Initial Visit
- CPT Code 99203 – Evaluation and Management, Initial Visit
- CPT Code 99204 – Evaluation and Management, Initial Visit
- CPT Code 99212 – Evaluation and Management, Established Patient
- CPT Code 99213 – Evaluation and Management, Established Patient
- CPT Code 99214 – Evaluation and Management, Established Patient
- CPT Code 97140 – Manual Therapy
- CPT Code 97110 – Therapeutic Exercise
- CPT Code 97750 – Physical Performance Examination
- CPT Code 99211 – Re-evaluation
- CPT Code 97112 – Neuromuscular Re-education
- CPT Code 97530 – Therapeutic Activities
- CPT Code 97010 – Hot/Cold Packs
- CPT Code 97014 – Electrical Stimulation (Unattended)
- CPT Code 97035 – Ultrasound/Phonophoresis
- CPT Code 97161 – PT Evaluation: Low Complexity
- CPT Code 97116 – Gait Training
- CPT Code 97162 – PT Evaluation: Moderate Complexity
- CPT Code 97535 – Self Care/Home Management Training
- CPT Code 97032 – Electrical Stimulation (Manual)
- CPT Code 97012 – Mechanical Traction
- CPT Code 97113 – Aquatic Exercise
- CPT Code 97124 – Massage
- CPT Code 97018 – Paraffin Bath
- CPT Code 97022 – Whirlpool
- CPT Code 97026 – Infrared Light
- CPT Code 97033 – Iontophoresis
- CPT Code 97039 – Laser/Other
- CPT Code 72020 – Radiologic examination, spine, single view, specify level
- CPT Code 72040 – Radiologic examination, spine, cervical; two or three views
- CPT Code 72070 – Radiologic examination, spine; thoracic, two views
- CPT Code 72072 – Radiologic examination, spine; thoracic, three views
- CPT Code 72100 – Radiologic examination, spine, lumbosacral; two or three views
- CPT Code 72170 – Radiologic examination, pelvis; one or two views
- CPT Code 72190 – Radiologic examination, pelvis; complete, minimum of three views
- CPT Code 72200 – Radiologic examination, sacroiliac joints; less than three views
- CPT Code 72220 – Radiologic examination, sacrum, and coccyx; minimum of two views
Importance of modifiers and CPT codes
With the use of CPT codes and modifiers, additionally known as standardized medical codes, medical professionals are able to provide customers, insurers, and other healthcare organizations with an accurate description of the services they provide. It is imperative for chiropractors to have access to these codes in order to correctly bill for their services and ensure that they are compensated fairly. When filing insurance claims, you must use the CPT code corresponding to the chiropractic procedure or service you received. Modifiers, however, provide additional information about the service, such as the kind or extent of the treatment.
Utilizing the correct codes and modifiers is vital because errors can result in claim denials, payment delays, and legal concerns. Accurate coding is not only helpful in documenting patient treatments and outcomes, but it also contributes to an overall improvement in the quality of care provided.
Accurate medical coding is required to ensure that chiropractors receive appropriate service payments. By adhering to the best practices suggested in this article, chiropractors will be able to improve the accuracy of their coding, decrease the number of claims that are denied, and boost the efficiency of their revenue cycle. Remember to stay current on coding changes, document everything well, and consider incorporating technology into your coding processes to make them more efficient. By doing so, chiropractors will be able to spend more of their attention on providing superior patient care while also minimizing the amount of time spent on administrative tasks.