How to Bill Chiropractic determination Codes For Medicare

Medicare Supplement Insurance Companies - How to Bill Chiropractic determination Codes For Medicare

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Billing chiropractic services for a Medicare patient can seem complex due to the amount of rules that are definite to the chiropractic profession. In this article, we will focus on how to bill prognosis codes correctly.

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For chiropractic claims, since Medicare only covers spinal manipulation for the revision of a subluxation, we must begin by having a prognosis of subluxation in the first position (primary) of the prognosis codes.

On a Hcfa claim form, this is Box 21D.

The only "approved" traditional prognosis codes (Icd-9) that Medicare will accept for chiropractic claims are as follows:

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified
-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified
-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified
-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified
-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified
-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you "name" the diagnosis, these codes in the list above are the only traditional codes that apply to chiropractic services in the Medicare program.

The use of these codes does not guarantee reimbursement, however, because the patient's healing description must document that Cms coverage criteria (medical necessity) has been met.

A big caution here, though. Failing to use these codes in the traditional (1st position) prognosis will virtually guarantee a Denial!

So, be sure to use the literal, prognosis codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!

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