ChiroCode Alerts - April 13, 2010
by LaMont J. Leavitt, President/CEO of ChiroCode Institute
1. National Guidelines Clearinghouse Publishes CCGPP Documents
2. New Medicare -GX Modifier
3. So How Many Modifiers Can Fit In Box 24D?
4. Health Care Reform - ACA Calls it a "Historic First" and a "Big Win" for Chiropractic
1. National Guidelines Clearinghouse Publishes CCGPP Documents
The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is very pleased to announce that the literature syntheses published in JMPT have now been accepted for inclusion in the National Guideline Clearinghouse (NGC) and are available at www.guideline.gov . The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.
This important recognition represents the culmination of a three-year effort by the best and brightest of chiropractic researchers reviewing and analyzing thousands of research articles in an effort to compile the most valid available clinical evidence. The CCGPP Scientific Commission is composed of dozens of doctors of chiropractic from around the United States and Canada and chaired by Dr. Cheryl Hawk. These doctors have donated thousands of hours of their time in this effort and deserve a resounding thank you from each and every doctor of chiropractic in this country. We would also like to recognize the countless number of people who logged in to the CCGPP site and provided valuable stakeholder input. Additionally, Dr. Claire Johnson, editor of JMPT, also deserves special recognition for the extraordinary assistance she provided in guiding CCGPP through the listing process.
"The CCGPP is very excited about the literature syntheses being accepted for inclusion by the National Guideline Clearinghouse", said Dr. Mark Dehen, CCGPP Immediate Past Chair. To have the CCGPP's literature syntheses and treatment recommendations listed is a significant and historic step in our long-term Dissemination, Implementation, Evaluation and Revision (DIER) process. This level of acknowledgment will make these literature syntheses broadly available to all of our stakeholders, better educating them about the chiropractic profession and encouraging collaborative opportunities. More importantly, it will provide another avenue to make this information available to our chiropractic practitioners as they seek to continue to increase the quality of care they provide their patients.
According to the agency's website, the NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
The spectrum of evidence utilized ranged from randomized controlled trials to case series and consensus opinion. The draft documents were made available for stakeholder review and comment on the internet in an effort to improve the transparency and promote profession-wide input before these documents were published in a peer reviewed journal.
The chiropractic profession owes a tremendous debt of gratitude to Dr. Cheryl Hawk, current Commission Chair; Low Back Cochairs, Drs. Dana Lawrence and William Meeker; Low Back Consensus Chair, Dr. Gary Globe; Myofascial and Fibromyalgia Cochairs, Drs. Howard Vernon and Michael Schneider; Tendinopathy Chair Dr. Mark Pfefer; Lower Extremity Cochairs Drs. James Brantingham and Gary? Globe; as well as all of their teams and research assistants.? We also thank our previous Commission Chairs, Drs. Skip Lantz, Jay Triano and Al Adams, as well as our current and former Council members. We also would like to acknowledge our tremendous debt to all of our benefactors, most especially our former Vendor Representative, the late ChiroCode founder, D. Henry Leavitt.
2. New Medicare -GX Modifier
If you missed Dr. Ron Short's -GX Modifier Webinar, here's your chance to get the latest on this new Medicare modifier. You and your staff are invited to watch the recorded replay and some of our more recent webinars at www.chirocode.com/webinars
Also, one of the big questions during the webinar was "how many modifiers can be used?" and the following alert topic answers that question.
3. So How Many Modifiers Can Fit In Box 24D?
By Dr. Ron Short, DC, MCS-P
During a recent webinar the presenter who shall remain nameless (but whose initials are me) stated that there was a limit of 2 modifiers for each code.. Some questions were asked and some research done. The results are below.
A thorough check of CPT 2009 Professional Edition by the AMA revealed nothing about any limits on the number of modifiers that can be used with a procedure code.
Checking the Medicare Claims Processing Manual, Chapter 26, Section 10.4 reveals; "Item 24D - Enter the procedures, services, or supplies using the CMS Healthcare Common Procedure Coding System (HCPCS) code. When applicable, show HCPCS code modifiers with the HCPCS code. The Form CMS-1500 has the ability to capture up to four modifiers."
Further checking the Medicare Claims Processing Manual, Chapter 23, Section 20.3 reveals; "Carriers/MACs and DME MACs are required to accept at least 2-position numeric or alpha modifiers and process both modifiers completely through the claims processing system (including any manual portion) as far as payment history."
So, what does this all mean? You can place up to four modifiers in box 24D of the CMS form but the Carrier/MAC is only required to process the first two. Therefore, be sure that the first two modifiers are the most relevant and most directly relate to getting paid and protecting your rights.
For covered services the first modifier should be the AT modifier if the patient is under active care. The next modifier should be the GA modifier is the patient has been given an ABN. No other modifiers should be used with covered services under Medicare.
For non-covered services the first modifier should be the GY modifier indicating that the service is not covered under Medicare. The next modifier should be the GX modifier if you used the voluntarily ABN to inform the patient that they are financially responsible for the service. You can then use the -25 modifier if you perform an exam on the same day as an adjustment.
The confusion resulting from this issue only serves to illustrate the complexity of Medicare and the importance of detailed research to get the full picture. Naturally, this information (along with much more) will be in the 2010 update to Medicare for Chiropractors (if Medicare will only stop changing things long enough for me to get the update finished).
4. Health Care Reform - ACA Calls it a "Historic First" and a "Big Win" for Chiropractic
The national health care reform bill signed into law by President Barack Obama was called a "big win" for the chiropractic profession by the American Chiropractic Association (ACA).
Read more: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54562
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