Modifiers in Chiropractic Medical Billing - PowerPoint PPT Presentation

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Modifiers in Chiropractic Medical Billing


Chiropractic medical billing codes tell the insurance company what procedures are performing and would like to be reimbursed for. – PowerPoint PPT presentation

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Title: Modifiers in Chiropractic Medical Billing

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Modifiers in Chiropractic Medical Billing
As per the recent study, it has been noticed
that Blue Cross and Blue Shield (BCBS) given
denials to chiropractic practices for the claims
billed with modifiers. Companies that offer
medical billing services identified that the
majority of the claims were denied owing to the
requirement of modifiers 25 and 59. According to
the Explanation of Benefits (EOBs), the modifiers
were utilized more than average or used
improperly.   In December 2017, the Illinois
Chiropractic Society (ICS) announced that the
cases they studied, the modifiers, and procedure
codes were billed rightly as per the information
of claims, but because of a code-editing feature
introduced by BCBS claims were denied. This
incident has pointed to the importance of the
usage of modifiers for Chiropractic Medical
Billing.   Proper utilization of modifiers can
escalate reimbursement. If codes are billed
without modifiers when it is required, the
carrier will deny the claim with justification on
the EOB of clubbing with another
service. Normally, an Evaluation and Management
service (E/M) is filed without a modifier.
According to the American Medical Association
(AMA), chiropractic manipulative treatment (CMT)
(98940-98943) is a type of manual service to
influence neurophysiological and joint function.
Modifiers in Chiropractic Medical Billing
Modifiers in Chiropractic Medical
Billing Modifier 25 Modifier 25 is utilized to
show that this is an important, independently
recognizable evaluation and management (E/M)
service by the same physician on the same day.
Modification of the E/M doesnt assure you the
reimbursement. There are insurance companies that
wont cover CMT and E/M on the same day. On the
other hand, some will consider paying for a new
patient (99201-99205) not for an old patient
(99211-99215). Modifier 25 is only applicable to
E/M services. GA Modifier This modifier
suggests that the Advanced Beneficiary Notice
(ABN) is on file and enables the provider to bill
the patient if not covered by Medicare. GY
Modifier Added to all services except the CMT
for Medicare claims, as all services excluding
Chiropractic Adjustment are not protected by the
Medicare Program when provided by a chiropractor.
Modifiers in Chiropractic Medical Billing
  • Modifier 59
  • Modifier 59 is utilized to show an important,
    separately recognizable non-E/M service by the
    same physician on the same day. Manual Therapy
    Techniques (97140) used by chiropractors is a
    common example of a non-E/M service. This
    comprises manipulation/mobilization and manual
    lymphatic drainage and manual traction-one area
    or more, every 15 minutes. As this coding (97140)
    involves modification, it can be updated with a
    59-modifier if it is carried out on the same day
    as a change (CMT).
  • X-set Modifiers
  • In January 2015, CMS published additional subsets
    of the 59-modifier, i.e. XE, XS, XP, and
    XU-modifiers that may be used instead of the
  • XE Separate Encounter a service that is distinct
    because it occurred during a separate encounter
  • XS Separate Structure a service that is distinct
    because it was performed on a separate
  • XP Separate Practitioner a service that is
    distinct because it was performed by a different
  • XU Unusual Non-Overlapping Service the use of a
    service that is distinct because it does not
    overlap the usual components of the main service

Modifiers in Chiropractic Medical Billing
The Active Treatment (AT) Modifier The Active
Treatment (AT) modifier was designed to define
the difference between active treatment and
maintenance treatment clearly. Medicare pays only
for active therapy and does not pay for
maintenance therapy. Claims should contain a
primary diagnosis of subluxation and a secondary
diagnosis that replicates the neuromusculoskeletal
condition of the patient. These are some of the
commonly used modifiers in chiropractic
billing.   Medical Billers and Coders is a
renowned medical billing service provider that
can effectively handle all your chiropractic
medical billing and Chiropractic Credentialing
Service needs and claim settlements. For more
information call us at 1-888-357-3226. Medical
Billers and Coders also have top Wound Care
Billing and Podiatry Billing RCM Managers.
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