Insurance Archives - Chiropractic Billing And Coding

M54.5 Low Back Pain Code Deleted

As of October 1, 2021, M54.5 (Low Back Pain) is no longer a valid diagnosis code. It has been replaced by more specific codes. This means that all your existing patients with a M54.5 diagnosis must be updated. The new valid codes are as follows: M54.50 Low back pain, unspecified M54.51 Vertebrogenic low back pain […]

NPI Numbers in Blocks 24j and 33a

The billing provider is the entity that is sending the insurance claim to the insurance company. This is usually the doctor’s corporation or the doctor himself if he is not incorporated or the company that is doing the billing for you. The billing provider is the entity that receives the insurance check when assignment is […]

R51 Headache Code Change

R51 – headache (cephalgia) became invalid 10-01-2020 as it has been replaced by more specific codes. Headache R51- Type 2 Excludes atypical face pain (G50.1) migraine and other headache syndromes (G43-G44) trigeminal neuralgia (G50.0) R51.0 Headache with orthostatic (relating to or caused by an upright posture) component, not elsewhere classified R51.9 Headache, unspecified ICD-10 coding […]

Billing Spinal X-Rays

Full spine x-rays are not considered to be of diagnostic quality. This is expecially true of 14×36 film. So if a chiropractor decides to x-ray the patient’s entire spine, he should take sectional views and bill the exam using three codes as follows: 72040 Radiologic examination, spine, cervical; 2 or 3 views 72070 Radiologic examination, […]

GP Modifier for Therapies

Insurance policies are written in segments or riders. Chiropractic services are covered under the chiropractic or physician portion of the policy but therapies are generally covered under a therapy portion. The therapy portion of the policy covers all therapy no matter who provides the service. This means that when a patient comes to you they […]

Tax ID, NPI, UPIN, PTAN, Provider and Taxonomy Numbers

Zero State Before you begin treating patients, you should setup the structure of your practice. First off, you should decide if you want to incorporate. A corporation provides a layer of protection for your assets. The laws governing incorporation vary state to state and there are multiple types of corporations so this decision should be […]

Modifiers 25 & 59

Modifiers are used to indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. Under normal circumstances, an Evaluation and Management service (E/M – exam) is filed without a modifier (99203 in this example). However, if you adjust the […]

Fees for Copying Records

All office records, test results, x-ray films etc. are the property of the clinic. The doctor is required by law to maintain the records for a period of time after the course of treatment has expired. Patients may request and are entitled to copies of their records but not the originals. This includes x-rays! Typically, the […]

CMT And E&M On The Same Visit

The chiropractic manipulative treatment (CMT) includes a pre and post service evaluation. The insurance companies, to their advantage, interpret this to mean that the “pre and post service” constitutes an Evaluation and Management service. When a CMT and E&M occur on the same visit/day, they will generally pay the least expensive service (the CMT) and […]

Paper Claim Printing Standards

Insurance companies use optical scanners to read paper claim forms and convert the information on them into an electronic format. This prevents the claim from having to be keyed into the computer by hand. Scanners can read approximately 2500 claims per hour and they have a 97 to 98 percent accuracy rate. Claims must meet […]

1 2 Next »