Chiropractic Billing Biggest Monthly Revenue Challenges

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Chiropractic Billing Biggest Monthly Revenue
Challenges
Chiropractic physicians are also known as
wellness physicians. Insurance companies and
patients are still jumbling through different
contracts to pay wellness physicians. At Medical
Billers and Coders (MBC) we cater to the
requirement of more than 70 chiropractic
physicians. Each physician has different
requirements based upon the demography, payer
contract, and patient care. Billers and Coders
have to systemize the claim generation and
submission according to the regulation and
requirements.   The requirements keep
differencing as the patient change, so we stay
flexible with the payment schedule. An update is
usually done through a series of questions which
makes sure we dont miss out on any criteria. The
challenge is to keep the claim error-free.
informed a biller. Tips to go through for
Chiropractic Billers and Coders Preventive
Evaluation and Management for New Patients A
comprehensive preventive medicine evaluation and
management of a patient inculcating different
 age and gender appropriate history, examination,
counseling/anticipatory guidance/risk factor
reduction interventions, and the ordering of
laboratory/diagnostic procedures, new patient
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Chiropractic Billing Biggest Monthly Revenue
Challenges

• 99381 infant (age younger than 1 year)
• 99382 early childhood age (age 1 through 4
  years)
• 99383 late childhood age (age 5 through 11
  years)
• 99384 adolescent age (age 12 through 17 years)
• 99385 18-39 years
• 99386 40-64 years
• 99387 65 years and over
• Preventive Evaluation and Management for old
  Patients
• Preventive medicine reevaluation and management
  of an individual.
• 99391 infant (age younger than 1 year)
• 99392 early childhood age (age 1 through 4
  years)
• 99393 late childhood age (age 5 through 11
  years)
• 99394 adolescent age (age 12 through 17 years)
• 99395 18-39 years
• 99396 40-64 years
• 99397 65 years and over

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Chiropractic Billing Biggest Monthly Revenue
Challenges
Codes 99381-99397 are covered by most insurance
plans when performed by an MD/DO these codes
are not covered by Medicare. Initial Preventive
Physical Examination (IPPE) for initial
chiropractic patients in Medicare This is a
Once-in-a-lifetime covered under the Medicare
benefit. This includes different lab tests to
check the patient health. Use HCPCS code G0402
for the initial preventive physical exam. This is
a face-to-face visit and the beneficiaries can
avail of this during the first 12 months of
Medicare enrollment. Medicare Annual Wellness
Visits (AWV) The AWV from Medicare includes the
establishment of or update to, family history and
health features. The goal is health promotion and
diseases prevention, however, clinical lab tests
are not included. AWV is not a routine medical
test and Medicare wont pay for regular
physicals. Use HCPCS code G0438 for the initial
AWV. This includes a personalized prevention plan
of service. This service is covered one time in
the 2nd year of eligibility. Co-pay,
co-insurance, and deductible waived.
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Chiropractic Billing Biggest Monthly Revenue
Challenges
Use HCPCS code G0439 for the subsequent AWV.
This includes a personalized prevention plan of
service. This service is covered one year after
the initial AWV. It does not include lab tests.
Co-pay, co-insurance, and deductible
waived. Physical or Manipulative Therapy
Performed for Maintenance rather than
Restoration Use HCPCS code S8990, except when
billing Medicare. Code S8990 can be used for
chiropractic adjustments once the patient has
reached maximum therapeutic benefit and has
transitioned to preventive/wellness care or
performance-enhancing care. To know more about
our chiropractic billing and coding services, get
in touch with us!