Billing chiropractic services for a Medicare outpatient can seem complex due to the number of rules that are exact to the chiropractic profession. In this article, we will focus on how to bill determination codes correctly.
For chiropractic claims, since Medicare only covers spinal manipulation for the revising of a subluxation, we must begin by having a determination of subluxation in the first position (primary) of the determination codes.
On a Hcfa claim form, this is Box 21D.
The only "approved" original determination 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 original codes that apply to chiropractic services in the Medicare program.
The use of these codes does not warrant reimbursement, however, because the patient's healing narrative must document that Cms coverage criteria (medical necessity) has been met.
A big caution here, though. Failing to use these codes in the original (1st position) determination will virtually warrant a Denial!
So, be sure to use the spoton determination codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!
How to Bill Chiropractic pathology Codes For Medicare
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