Common chiropractic coding errors

Published: 2010-07-04 20:28:40
Author: Ted A. Arkfeld | ChiroEco | April 2010

Inaccurate coding and billing is a huge financial drain on the Medicare system, but it is also responsible for revenue leaking out of practices nationwide. A conservative estimate of between 10 percent to 30 percent revenue losses occur in chiropractic offices due to incorrect coding.

But before you rush to your insurance CA’s office to start the blame game, take a look at the coding policies differences.

In a medical office, a large percentage of its insurance staff has a certified professional coder (CPC) designation. The CPC will review the patient file and charting notes to determine the most appropriate CPT code and ICD-9 diagnosis code to submit. If the practice is large enough, the CPC will then submit this to the biller who inputs it into the billing software and a claim is produced.

Chiropractic takes an entirely different approach. You choose the CPT and ICD-9 diagnostic codes either by circling on a fee sheet, routing slip, or super bill, and then hand this to your front-desk receptionist or biller. The biller then inputs it into the software and a claim is produced.

The potential for an inaccurate code starts immediately by placing this step in your hands and not in the hands of someone specifically trained in coding. Chiropractic doesn’t have coders (unless your insurance CA is a CPC), only billers. You were not trained in coding while in school and now that you’ve entered into practice you tend to focus on patient care rather than how they will be reimbursed. It is a flawed system that the Office of the Inspector General (OIG) has revealed in its last two major reports.

Profiles are based on numbers

Your practice profiles are based on CPT and ICD-9 coding numbers. If those numbers are the same for every patient who comes into your office, your profile will be a flat line across the page.

This creates a red flag for your practice, with a strong possibility of inviting Medicare and other third-party payers to probe deeper into your coding and billing policies. Not every patient enters your office with the same chief complaint(s) and therefore should not receive a cookie cutter treatment plan.

Base all Evaluation & Management (E/M) codes on what the patient presenting symptoms are, the work involved in determining the anatomical structure responsible for producing pain, and the overall severity of the condition — which altogether will allow you to meet or exceed the criteria for the various E/M codes.

Do not consider time spent with a patient as an important factor, you could easily spend 60 minutes face to face with a patient, yet your documentation only supports a 99201 level examination.

New patient examinations

E/M code selection continues to be problematic for chiropractors with many believing they will not be paid for these services. Not only is this incorrect, but it is one of the few areas where you receive the same amount of reimbursement as MDs and DOs.

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