Chiropractic Coding | The Strategic Chiropractor

Chiropractic ICD-10 Training: Too Late, Too Early? (Part 10 of the 13 Things Series)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on February 21st, 2013

I’ve placed this item near the end of our “13 Things series” because, quite frankly, who knows if ICD-10 will actually happen on schedule or at all.

If you’re an ICD-10 threat follower, you undoubtedly know that the powers that be have cried wolf before. But at the time of this writing (Feb 2013), there are some strong indications that ICD-10 will actually go forth. Here’s why:

There already exists a “code freeze” as far as Diagnosis codes go (ICD-9) and, except in cases, for new diseases or new procedures, there will are no new codes planned.
After October 2013, there will be no new codes issued on ICD-9 at all.
Any planned new additions to the codeset after October 2013 will take place in ICD-10

Recommendations for ICD-10 Training for Chiropractors and Their Staff

Even though it looks much more likely that the ICD-10 will go through, I’d have some serious hesitations about training my staff anytime before June 2013 (at the earliest), just to make sure that the ICD-10 thing will really happen on time.

Unfortunately, coding “experts” have already been holding seminars this and even last year on ICD-10. I’m sure that is good income for them but I’m sorry – if ICD-10 gets delayed to 2015, do you really expect your staff to learn it this year, not use the codes AND remember everything in a couple of years? For some, even learning things in 2013 that won’t be used until 2014 is pushing it.

Wait it out. You’ll hear the rumbling getting closer. Then act!

2013 CPT Code Changes for Chiropractic Offices (Part 4 of 13 Things Chiropractors Will Have to Change Series)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on January 8th, 2013

Topics: chiropractic billing, chiropractic coding

Fortunately, there are not many changes to with the new 2013 CPT Codes that will affect chiropractors. But there are some clarifications and updates that will affect some chiropractic practices. Here they are the most relevant CPT changes for 2013: Read More

13 Things Chiropractors Will Have to Change in 2013 (Part 2)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on January 2nd, 2013

Topics: chiropractic and manual therapy, chiropractic coding

2. Watch Manual Therapy. After my email inbox began to explode with complaints about Aetna, I had the privilege of delivering bad news about manual therapy to thousands of chiropractors across the USA. (See my previous blog posts on Aetna Denials for Chiropractic and Manual Therapy Part 1 and Aetna Denials for 97140 and Chiropractic Adjustments Part 2 for more details)

And while Aetna has officially declared that they will no longer pay for the chiropractic adjustment and manual therapy after March 2013, the real trouble may lie ahead. Here’s why: Read More

Aetna Denials for 97140 & Chiropractic Adjustments (Part 2)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on November 20th, 2012

Topics: chiropractic and manual therapy, chiropractic billing, chiropractic coding, chiropractic insurance

As I mentioned in my previous blog post Aetna Denials For Manual Therapy (97140) and Chiropractic Adjustments, it appears that Aetna is up to no good again in terms of denying claims for chiropractic adjustments and manual therapy (97140) services performed on the same day.

For those of you who read the post, you will recall that I did not point the finger entirely at Aetna and mentioned the fact that there are four distinct criteria that need to be met to get your claims paid if your are performing these two services on the same day. Generally speaking, if you apply those criteria, you should anticipate payment; if you don’t, it’s your fault – you did it wrong! Read More

Aetna Denials for 97140 Manual Therapy and Chiropractic Adjustments (Again!)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on November 6th, 2012

Topics: chiropractic and manual therapy, chiropractic billing, chiropractic coding, chiropractic documentation

If you haven’t been personally afflicted by the latest round of shenanigans from Aetna in regards to bundling chiropractic adjustments and manual therapy (97140), be forewarned – Aetna’s abusive practice is spreading quickly. Over the last several weeks, I have been inundated with emails from perplexed chiropractors in all parts of the country who have suddenly noticed that their 97140 claims are being routinely denied by Aetna.

Unfortunately, in case you aren’t up to date on your history, Aetna’s bad habit of making these “errors” in claims processing has been tried before and they have been sued for this in the past as well. And, although we are certainly capable of making errors in the areas of chiropractic billing, coding and documentation, the blame in this case rests squarely on Aetna. Read More

Why Your Chiropractic Assistant, Fraud, & Insurance Verifications are Ruining Your Revenues ( & What Chiropractors Can Do About It)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on October 2nd, 2012

Topics: chiropractic billing, chiropractic business, chiropractic coding, chiropractic documentation, Uncategorized

These days, it’s tough to tell where problems start. Some of you know you, doctor, are the primary contributor. For others, it’s the staff. Still others feel it’s insurance or even healthcare at large.

You all may be correct – which is why this article may help point you in the right direction…

Recently, I saw an interesting graphic that depicted the impact of identity theft on healthcare fraud. The graphic illustrated a little mentioned problem in the hunt for fraud and the audit frenzy that is occurring in today’s healthcare: thieves can steal a person’s (or doctor’s) identity and bill for services to receive reimbursement. And it’s happening all the time. Witnessed the millions recovered by Medicare for fraudulently billed DME (for example, wheelchairs provided and paid for by Medicare to dead people).

Before you think chiropractic is immune, think again of a larger issue that enables fraud to happen: patient’s no longer understand their health insurance. And if they don’t understand insurance, they are not only more apt to be victims of crime but also to not reap the full benefits due them. They are more likely to encounter problems that may get them upset at you. And, in turn, less likely to want to use their insurance for your care, thus, reducing your income.

With that in mind, below are a few vital, proactive strategies that chiropractors can employ to minimize our audit risk and to preserve good patient relationships: Read More

How to Survive a Chiropractic Audit (Part 2)

Written by Tom Necela, DC, CPC, CPMA, CCP-P on August 22nd, 2012

Topics: Chiropractic Audits, chiropractic billing, chiropractic coding, chiropractic documentation

In Part One of this article “How to Survive a Chiropractic Audit” we focused on what to do if and when you get notification that your chiropractic practice is being audited. My primary focus in that article was to prevent you from having a heart attack, from fleeing to a fortress in Slovenia, from unnecessarily declaring bankruptcy or from throwing in the towel and ending it all. Unfortunately, in my work helping chiropractors with their audits, I’ve seen all of the above

(Ok, maybe not fleeing to Slovenia, but if you’ve got to leave the country, it’s a nice place to be, especially around Lake Bled in the summertime…But I digress.)

In Part Two, we are going to focus on being a little more proactive than having your passport ready or your fingers crossed. Let’s focus on preventing the audit. Read More

Chiropractic E/M Challenges: When a NP Isn’t, When Mod -25 Just Won’t Do & More!

Written by Tom Necela, DC, CPC, CPMA, CCP-P on August 2nd, 2012

Topics: chiropractic coding, chiropractic documentation, E/M Codes

One that you can say about billing, coding & documentation for your chiropractic services is that it is constantly changing. This certainly may cause frustration to many DC’s who believe they are doing things right only to find out that their claims are suddenly rejected, additional paperwork is requested or – in the worst case scenario – a post-payment audit demands money back.

I’m not much of a conspiracy theory guy but it does indeed look, at times, as if the insurance payers are constantly changing the rules to cause us to stumble. Fortunately, I am sick and twisted enough to enjoy watching THEM and reporting new changes and challenges to YOU.

Here’s the latest in the way of insurance shenanigans that is making its way across our country in the form of your E/M codes. Read More

Medicare Issues ABN Clarifications for Chiropractic Billing

Written by Tom Necela, DC, CPC, CPMA, CCP-P on July 26th, 2012

Topics: chiropractic billing, chiropractic coding, chiropractic compliance, Chiropractic Medicare, Medicare ABN

In perhaps what many would consider a rare moment of clarity, NGS (the Part B Medicare carrier) issued a statement recently to clarify some confusion on the use of the ABN for chiropractic services. Whether or not NGS is your carrier, this article can serve as a helpful reminder to make sure you are using the ABN properly in your office.

Specifically, the NGS press release focused on three common pieces of misinformation they see with respect to chiropractors’ usage of the ABN form. In virtually every seminar I present — regardless of the location — there is much confusion about how to use the Medicare ABN properly so I would agree that this are necessary reminders. In brief, here they are: Read More

How to Correct Chiropractic Billing and Documentation Errors

Written by Tom Necela, DC, CPC, CPMA, CCP-P on May 22nd, 2012

Topics: chiropractic billing, chiropractic coding, chiropractic documentation

Mistakes happen. The average busy chiropractor either fails to bill, code and document services correctly and unfortunately, their staff also misses it. The claim hits the insurance company with the bad info intact.

Next, the DC contacts me with a series of questions, depending on the situation… Read More

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