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

52 Modifier

Question: 

We report the 52 modifier for reduced services for our time based codes but have recently been receiving denials.  Why could this be?

Answer: 
Use of the 52 modifier on time based codes in order to report a reduced services due to lesser time being spent than the amount of time defined within the code description has been deemed inappropriate use of the 52 modifier.  Services that are performed for less than one full unit are not to be reported.  A full unit per code descriptions is 15 minutes although the CMS policy for rounding to the nearest 15 minutes is generally accepted by payers.  For example, one unit would be 8 - 23 minutes of hands-on care for a timed service.  Individual payers may also have specific rules regarding the reporting of timed services.  In order to comply with billing guidelines, practices should review these policies.  
A couple of examples for you are linked here and here (on page 8).  
You may also reference your 2015 ChiroCode DeskBook page H72 and/or the March 2014 CPT Assistant.

PQRS

Question: 

We successfully reported the PQRS Quality measures in 2013 but our 2015 Medicare payments are still being penalized by 1.5%.  How can we have this corrected?

Answer: 
If you did satisfactorily participate in PQRS in 2013 according to the guidelines and believe you are being erroneously penalized for non-participation, you can now appeal this determination.  
Practices who wish to appeal this determination can request an informal review from CMS now through February 28th.  Link here to the Quality Net portal and follow the steps to request this informal review in order to appeal the penalty that has been assessed for PQRS.  Here also is the CMS guide that can assist you in properly requesting an informal review.
You will also want to set up a username and log-in with Quality Net to view your practice Feedback Reports and to get additional support for PQRS.  Viewing your Feedback Report will help you to potentially avoid future penalties.
As a reminder, the deadline for this appeal is February 28th so practices must be proactive in properly requesting this appeal before the review period is closed.


Code for Supplements

Question: 

We sell supplements in our practice and have always used the 99070 code.  However, since this is a generic code, we use it for other supplies that we sell too.  I wonder if there is a more specific code that we can use for supplements?

Answer: 

 

Yes there is a more specific code for supplements.  Actually, there is likely another code that more clearly defines your other supplies as well.  These codes can be found in the HCPCS Supplies section of your Chirocode Deskbook or if you are subscribed to Find-A-Code, you can find the codes there as well.  
A few examples of more specific codes for nutrients include the following:
A9150 - Non-prescription drugs [OVER THE COUNTER (OTC) BOTANICALS OR NUTRACEUTICALS]
A9152 - Single vitamin/mineral/trace element, oral, per dose, not otherwise specified
A9153 - Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified
Do be sure to review these code definitions your current year ChiroCode Deskbook and also it would be good to check the HCPCS supplies section for more clearly defined codes for other supplies that your office is assigning the 99070 code to.  

 

Quick Questions

  [ 1 of 15 ] 2 3 4 5 Next  

52 Modifier

We report the 52 modifier for reduced services for our time based codes but have recently been receiving denials.  Why could this be?

read more...read more...

PQRS

We successfully reported the PQRS Quality measures in 2013 but our 2015 Medicare payments are still being penalized by 1.5%.  How can we have this corrected?

read more...read more...

Code for Supplements

We sell supplements in our practice and have always used the 99070 code.  However, since this is a generic code, we use it for other supplies that we sell too.  I wonder if there is a more specific code that we can use for supplements?

read more...read more...

Medicare Advantage Plans

Q. We are seeing many Medicare Advantage patients, many of which have plans with a co-pay that is higher than the reimbursement amount for a service. An example is $32.66 for 98941. When sending these claims to the payer, the EOB returns the members responsibility as $35 for a 98941. Don’t these plans have to follow the Medicare fee schedule?

read more...read more...

Billing for Cupping and Moxibustion Treatments

Our office is considering adding a massage therapist that performs standard massage techniques as well as cupping and moxibustion.  We are wondering if there is a way to bill insurance for the cupping and moxibusion treatments?

read more...read more...

Fee Schedule

 

Our office has not ever updated our fee schedule.  We use the same fees for several of years.  We are concerned of this now because we have added a couple of new services and are unsure if our fee schedule makes sense.  Is there a way to evaluate fees?

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Blood Pressure Measure for PQRS in 2015

 

I was told that we are no longer required to do the blood pressure measure for PQRS in 2015.  Is this accurate and do you have a reference?


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Codes for Wellness or Integrative Services

Our office provides a lot of wellness or integrative services.  Many of these services are not covered by insurances.  Our obstacle isn't in trying to get by insurance as we collect the proper acknowledgement that these services are patient responsibility.  However, the struggle we do have is in understanding how to determine codes for these services for data entry.  Currently, we have a a list of codes that we have created internally which seemed to work for a while but now has become confusing.  It is difficult to decipher office statistics and when adding new staff, it is difficult to prevent errors in data entry since our codes are loosely defined and there isn't a reliable resource to verify them.  Due to these increasing obstacles I wonder if there is a better way?

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Code for Hyperbaric Oxygen Chamber

Our office just got a hyperbaric oxygen chamber.  We understand there may not be insurance coverage but are unable to find a code to use for this service.  Is there one available?

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GP Modifier Rule

What is the rule when using the GP Modifier?

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What to charge if you don't participate with EHR and/or PQRS?

As a non-par provider with Medicare, how do we know what to charge if we did not participate with EHR and/or PQRS? 

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PQRS for 2015?

Are there any changes to PQRS for 2015?

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Confused about Medicare appeals?

Medicare appeals are very confusing.  Where can we learn about our requirements and the process for appeals?

read more...read more...

Penalties for not participating in PQRS or Meaningful Use

We are Non-Participating with Medicare and do not accept assignment.  We also have not participated in the PQRS or Meaningful Use programs.  We understand there are penalties to be assessed as of January 1, 2015 for this but are unsure where to find that information.  Can you help?

read more...read more...

Rules for Locum Tenens Billing

What are the rules for Locum Tenens Billing?

read more...read more...
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