Quick Questions
Chiropractic Consulting - Quick Questions by ChiroCode

Chiropractic Quick Questions - Current and Past

ChiroCode receives and answers hundreds of Quick Questions each month from our customers.  Customers who purchase the ChiroCode Membership are able to email questions directly to the experts at ChiroCode.  Professionals who have chosen the ChiroCode Premium Membership may also contact our Quick Questions hot line for instant answers.

ChiroCode accumulates the questions and answers and adds them to the ChiroCode KnowledgeBase which is available to Premium Memberss.  Also ChiroCode features a new Quick Question and Answer each week that appears on our home page along with the two prior questions.  These questions and answers are also shown below.  This page also contains the question portion from prior week's Quick Questions.  A full archive of all the ChiroCode Quick Questions and Answers can be found in the ChiroCode KnowledgeBase.

Premium Membership Sample:  Top 10 Frequently Asked Quick Questions - Answered by ChiroCode

Current Quick Questions

Should I have the patient sign an ABN for every adjustment, just in case?

Question: 

I want to be able to collect from a patient if Medicare does not pay.  Medicare seems to deny care at random.  Should I have the patient sign an ABN for every adjustment, just in case?

Answer: 

The ABN must be signed in order for you to be able to collect for covered services (that is 98940-98942 or CMT) that Medicare determines are not reasonable or necessary.  In the Medicare Learning Network ABN Booklet (ICN 006266), it states on page five that we are prohibited from issuing ABNs on a routine basis (that is, where there is no reasonable basis to expect that Medicare may not cover the item or service).  Simply stating that Medicare could deny anything anytime is not a "reasonable basis".  A "reasonable basis"' would be that you know Medicare's guidelines and you suspect that the questionable service does not meet them.  By using the AT modifier with a CMT code, you are telling Medicare that you believe that the service is payable (i.e. medically necessary).  Instead of assuming that Medicare denies at random, for no apparent reason, providers should get familiar with what Medicare considers to be medically necessary, and bill according to their guidelines.  They should then use the AT, expect to get paid, and appeal if denied.  If they don't meet the criteria according to the Medicare Benefit Policy Manual, chapter 15, and their Medicare Contractor's LCD, they should consider it maintenance, and issue an ABN.  See pages C18 thru C22 in the 2014 DeskBook for specifics. 

What if my Medicare patient refuses to fill out the outcome assessment questionnaire?

Question: 

What if my Medicare patient refuses to fill out the outcome assessment questionnaire?

 

Answer: 

Note it in your documentation and inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if they don’t want to follow Medicare’s protocols.   

Thanks to Ron Short, DC, MCS-P, CPC for providing this answer. He can be found at http://www.chiromedicare.net.

Our Medicare contractor is auditing claims with 98942

Question: 

Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?

 

Answer: 

Using the code 98942 indicates that you determined that it was medically necessary to adjust all 5 of the spinal regions. You documentation needs to reflect that fact, including that the patient had complaints in all five regions. The 98942 is a favorite target of auditors because many providers adjust full spine without establishing medical necessity for all five regions. Essentially, each area must have a patient complaint, relevant objective findings, a clear plan for resolution, and demonstrable progress.   

 

Quick Questions

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Should I have the patient sign an ABN for every adjustment, just in case?

I want to be able to collect from a patient if Medicare does not pay.  Medicare seems to deny care at random.  Should I have the patient sign an ABN for every adjustment, just in case?

read more...read more...

What if my Medicare patient refuses to fill out the outcome assessment questionnaire?

What if my Medicare patient refuses to fill out the outcome assessment questionnaire?

 

read more...read more...

Our Medicare contractor is auditing claims with 98942

Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?

 

read more...read more...

Is it okay to download the outcome assessment questionnaires

Is it okay to download the outcome assessment questionnaires or must we legally order them from somewhere, and if so, where do we order them?

 

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If orthopedic tests are negative

If orthopedic tests are negative, do you need to still list them in your treatment notes?

 

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Where can you get a list of standard chiropractic abbreviations?

Where can you get a list of standard chiropractic abbreviations?

 

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If the patient signs an ABN at beginning of treatment plan

If the patient signs an ABN at beginning of treatment plan, do they need to sign a new one when they go on maintenance? Or is the one they signed okay since maintenance care is listed on it?

 

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What percentage of improvement is REQUIRED

What percentage of improvement is REQUIRED using outcome questionnaires for Medicare to support treatment and how often do we need to do Outcome Assessment questionnaires; every 2 weeks or every 4 weeks?  

 

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I electronically sign my records; but if I find a mistake

I electronically sign my records; but if I find a mistake, I re-enter the SOAP notes for the same date and add the correction because once the records are electronically signed, you cannot change them; Is that OK for Medicare purposes to duplicate the SOAP notes twice to fix the error ?  

 

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I sometimes forget to sign my treatment note each visit.

I sometimes forget to sign my treatment note each visit. If records are subpoenaed can I go back and sign each treatment note prior to copying?

 

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For Medicare, do we have to provide diagnosis codes for the sacrum, lumbar and pelvis for a 98941?

For Medicare, do we have to provide diagnosis codes for the sacrum, lumbar and pelvis for a 98941?

 

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For Medicare, does a treatment plan have to be done on day one? What about waiting for X-rays?

For Medicare, does a treatment plan have to be done on day one? What about waiting for X-rays?

 

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Does the use of the ľAT modifier, or rules about maintenance care, apply to Medicare Advantage Plans?

Does the use of the –AT modifier, or rules about maintenance care, apply to Medicare Advantage Plans?

 

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Where can I find out about the updates to Medicare fees?

Where can I find out about the updates to Medicare fees? In CA, Noridian has not updated the fees yet.

 

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Should PI case's be contested when denied for IMR denial?

I had a PI case that was paid but discounted up until the last bill. The last bill was for an adjustment, manual therapy and acupuncture and was all denied based on an IMR denial. Should this be considered as final and written off or is it something that I can contest?

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