Chiropractic care is an important aspect of treatment of muscle and bone disorders and has enabled patients to find relief without having to undergo surgeries. However, there are certain challenges that may be associated with the financial management of the chiropractic practice, including the procedure that is involved in billing and coding. Among them, CPT codes are particularly essential in the documentation of services offered in chiropractic practice.

In this blog, we will discuss CPT codes for chiropractic services, the necessity for proper code selection, and Medicare’s guidelines for these codes. If chiropractors are able to learn about these coding practices, presumably, they will be able to improve their billing, decrease rejection rates, and, thus, spend more time providing optimal patient care.

What are CPT Codes in Chiropractic Care?

In the chiropractic industry, CPT codes refer to standardized codes developed to facilitate documentation and billing of medical services and procedures provided by chiropractors. CPT, or Current Procedural Terminology, is a terminology system created by AMA that can be used to standardize the reporting and reimbursement for services in the healthcare field across disciplines. In chiropractic care, these codes encompass spinal manipulation, extraspinal adjustments, manual techniques and passive modalities, therapeutic exercises, along with other forms of therapy like electrical stimulation and ultrasound therapy. Every CPT code relates to a specific procedure or therapy and thus enables chiropractors to convey the kind of service delivered to insurance companies, Medicare, and other third-party payers.

Common CPT Codes for Chiropractic Procedures

Here are the most frequently used CPT codes in chiropractic care:

CPT Codes for Spinal Manipulation (98940 – 98942)

Spinal manipulation is a core service provided by chiropractors, and CPT codes 98940 to 98942 describe spinal manipulative therapy (SMT) depending on the number of regions involved:

• 98940 – Chiropractic manipulation of 1-2 spinal regions
• 98941 – Chiropractic manipulation of 3-4 spinal regions
• 98942 – Chiropractic manipulation of 5 spinal regions

These codes are charged according to the number of areas that one adjusts in a session of chiropractic.

CPT Code for Extraspinal Manipulation (98943)

Extraspinal manipulation can be defined as adjustments of tissues and joints in areas other than the spine, like the limbs. The CPT code 98943 includes chiropractic manipulations of the extremities such as shoulders, knees, and wrists. This code is necessary when the treatment is directed on non-spinal joints.

CPT Codes for Therapeutic Exercises (97110)

Therapeutic exercises, which are normally recommended by chiropractors and are meant to enhance flexibility, strength, and movement. CPT code 97110 pertains to exercise, reactivation, and preservation of joint movement following injury or dysfunction of a specific body area. This code prescribes record-keeping of the amount of time spent on each particular therapeutic practice.

CPT Codes for Manual Therapy (97140)

CPT code 97140 covers the manual therapy techniques used in treating the patient, including mobilization, myofascial release, and trigger point therapy. These techniques complement spinal adjustment and can be employed by chiropractors as a way of addressing soft tissue.

CPT Codes for Neuromuscular Reeducation (97112)

Neuromuscular reeducation is aimed at re-establishing axial control, pathologic movement, and muscle memory. CPT code 97112 pertains to services that enhance balance, coordination, posture, and proprioceptive skills.

CPT Codes for Electrical Stimulation (97014, G0283)

Electrical stimulation is one of the most frequently used procedures by chiropractors to help manage pain and inflammation. Unattended electrical stimulation is coded as 97014 while the code for Medicare patients under unattended electrical stimulation is G0283.

CPT Codes for Hot/Cold Packs (97010)

CPT code 97010 is used for the application of hot or cold packs, which chiropractors often use to reduce swelling and ease discomfort before or after a session.

CPT Codes for Ultrasound Therapy (97035)

Another effective technique that chiropractors apply when treating the tissues is the use of ultrasound therapy. 97035 refers to therapeutic ultrasound procedures that can be used on soft tissues during chiropractic care.

Medicare Guidelines for Chiropractic CPT Codes

Medicare rules for chiropractic CPT codes are very rigorous and apply only to the case with spinal subluxations, meaning misaligned vertebrae that interfere with nerve impulses. Currently, Medicare reimburses only one chiropractic service, and that is the spinal manipulation, intended to correct this subluxation. Some of the covered CPT codes include 98940, which involves the chiropractic manipulations of 1-2 spinal regions; 98941 for the chiropractic manipulations of 3-4 spinal regions; and 98942 for the manipulations of 5 spinal regions. These codes represent the number of spinal regions treated during a session, based on which the payment can be made.

Besides spinal manipulation therapy, Medicare does not include any other form of adjunct therapies such as extraspinal adjustments (CPT 98943), therapeutic exercises, electrical stimulation, ultrasound therapy, etc., or any such supportive care. Chiropractors working with Medicare patients are required to prove that the treatment is necessary from a medical standpoint, necessary to correct a subluxation, and properly documented. The documentation must contain a diagnosis of subluxation, a description of symptoms present in the case of the patient, and objective findings proving the functional gains of the patient after the treatment.

Proper Documentation for Chiropractic CPT Codes

Clear documentation procedures need to be maintained to ensure that claims are processed seamlessly. When billing for chiropractic services, it’s important to include the following details:

• Diagnosis: A well-documented diagnosis to justify the need for a chiropractor.
• Region Treated: Specific information regarding what parts of the spine or extremities were treated.
• Treatment Time: In codes such as 97110, the clinician should record the time spent on each activity in order to get paid and not have the claims denied.
• Functional Goals: Explain how the treatment advances the goals of better patient function or diminished pain.

Common Mistakes to Avoid in Chiropractic Coding

Here are common mistakes to avoid in chiropractic coding:

Billing for Non-Covered Services

For Medicare patients, only spinal manipulation for subluxation is admissible. Coding for the treatment of other areas, such as the manipulation of joints that are in regions other than the spine and the therapeutic exercise auxiliary services, which are not compensated, results in denial.

Incorrect Documentation

Lack of documentation or irregularity in documentation is a serious problem. It is always important to make sure that the notes taken correspond to the services that have been billed, diagnosis, regions treated, and medical necessity.

Under/Over-Coding

Billing inaccuracies can be brought about by entering codes corresponding to fewer or more spinal regions than the treated ones (CPT 98940-98942). Under-coding might lead to lower payment, while over-coding, on the other hand, leads to audits or denial of payment.

Improper Use of Time-Based Codes

For codes such as 97110 (therapeutic exercises), it means that the amount of time spent has to be recorded. Omission of the specific period can lead to claim rejection or audit.

Not Staying Updated on Payment Guidelines

Chiropractic care usually requires health insurance carriers to have certain policies regarding this practice. Lack of compliance with these guidelines is likely to result in programming errors and payment problems.

Staying clear from these mistakes means fewer hitches in the claims process and fewer chances of denial or audit.

Conclusion

In conclusion, it is imperative to recognize and apply the appropriate CPT codes regarding chiropractic to avail billing processes, particular reimbursement, and prevent frequent coding errors. Good documentation and compliance with payer rules can greatly minimize the risk of claim rejection and audit. 

However, the challenges that are associated with billing of chiropractic can be cumbersome and may also involve errors. When you outsource your billing to MedHeave Medical Billing Services, you make sure that you get proper coding, prompt payment of claims, and most importantly, you have time for your patients. MedHeave’s expert team has a vast experience in chiropractic billing, ensuring optimized reimbursement and minimal hassles.

Contact us for further details.