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

Penalties for not participating in PQRS or Meaningful Use

Question: 

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?

Answer: 
 You are correct.  For non-par - non-assigned claims, there is a negative adjustment that the providers must calculate on their own in order to follow guideline and stay within medicare regulation pertaining to fees and also to the penalties that are scheduled to be assessed beginning in 2015.  
Please take a look at the CMS document linked below.  This describes the negative adjustment rules and purposes as well as demonstrates examples of how these adjustments are to be calculated.  Note also that each Medicare Administrative Contractor will also provide limiting charge amounts after applying the applicable negative adjustments.  Be sure to reference your local Medicare Carrier website for additional assistance with this calculation.

Rules for Locum Tenens Billing

Question: 

What are the rules for Locum Tenens Billing?

Answer: 
A Locum Tenens provider is one that works in the place of the regular physician for a short duration of time.  Guideline allows this time period to be a 60 day maximum unless specific criteria for Locum Tenens renewal can be met.  Locum Tenens does have specific criteria and usually applies when a substitute doctor would be brought in to your office to cover your original doctor's actual schedule during the time he/she is absent. Services by the Locum Tenens provider would be performed at the facility that your doctor's NPI and group are registered. 
When submitting claims for a Locum Tenens provider, your office or billing service would submit claims just as you do for your original provider, including using the original provider's NPI.  The modifier Q6 must be appended to each service code rendered by the Locum Tenens provider. 
There are specific guidelines in place that must be met in order for a practice to properly hire and submit for a Locum Tenens provider and practices that utilize fill in (Locum Tenens) providers, must be aware of and adhere to these guidelines.  Additionally, there are general requirements for Locum Tenens providers that must also be met, such as being licensed in that state and able to fulfill the schedule and duties of the regular provider.
Please reference the following links that address the general definition and rules for utilizing Locum Tenens providers:
Note also that individual carriers may have their own rules in addition to what is standard for Locum Tenens providers.  As a result before making an assumption that coverage and benefits would remain the same, and it would be good to check with those carriers and obtaining their written policy regarding Locum Tenens.

Modifier 59

Question: 

Q:  Some of our payers appear to be denying claims where the 59 modifier is used.  In the past, we have never had trouble with these claims or using this modifier.  Why could this be?

Answer: 
A:  CMS has recently deemed modifier 59 as one of the most common modifiers used and also one of the most common modifiers used incorrectly.  As a result of this, as of January 1, 2015, CMS has added more specific coding options that are intended to be used in place of the 59 in many cases.  Certainly this applies to all Medicare/Medicaid claims in which the 59 modifier may appear (note that many other provider types use this 59 modifier on CMS claims, though it isn't necessarily as common in chiropractic).  This update applies to Medicare/Medicaid claims as of the beginning of the new year.  However, CMS does lay the foundation for other payers as well and with this change, many other payers are likely to follow suit in 2015.  However it is important to note in regards to your question, that there have already been some reports of payers already implementing this change for the use of modifier 59.  A good first step for you would be to call to confirm this with your payer(s) that are unusually denying claims with the 59 modifier or possibly to review their chiropractic policy to determine if any updates or new publications to this effect have been released.  If this does turn out to be the reason for your unexpected denial, you will most likely be using the XS modifier in place of the 59 for these payers.  Although, do reference the other new modifiers and definitions as well so you can be sure to use the one that is most appropriate.  
Please see the following references for more information on the changes that are impacting use of the 59 modifier:

Quick Questions

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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...

Modifier 59

Q:  Some of our payers appear to be denying claims where the 59 modifier is used.  In the past, we have never had trouble with these claims or using this modifier.  Why could this be?

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How Long Must We Keep Records

Q:  Our office is planning to dispose of aged patient records.  Is there a specific time frame that we are required to keep records for or  other rules that we should know about first?

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Cox Flexion Distraction

If I perform a regular high-velocity adjustment, side posture, on the low back, as well as COX distraction on the cervical region, may I bill a CMT code as well as 97140 for the flexion-distraction?

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Chiropractors cannot Opt Out of Medicare

I am looking for the specific wording from Medicare as to their “opt-out” policy with regards to Chiropractors. Can you provide that?

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One-Region Adjustment or Three

If I treat a patient by performing a Chiropractic Manipulative Treatment (CMT) to the pelvic region, the sacrum, and L5, is this a one-region adjustment, or three?

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Supply Codes

Is there more specific codes for supplies rather than using 99070?  

 

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Medicare Rules for Box 14

When initially submitting for a Medicare patient, what is the rule for filling out box 14? Also, what about box 15?  

 

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After-hours office visits

Is there a code to bill to insurance for after-hours office visits?

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Is it okay to email records?

Is it okay to email records?

Our EHR software says that one way to meet meaningful use is for us to be able to provide patients with timely electronic access to their records via email. I read somewhere that emailing patients is not recommended because both parties emails must be encrypted, but we don't know if the patients email is encrypted, therefore we should not do this. Do you know of other ways to meet this requirement for the EHR?

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Coding for two Chiropractic Adjustments (same day)

We have a patient who on two separate occasions came in in the morning for a chiropractic adjustment and then in the afternoon of the the same day for another chiropractic adjustment.  Do I need to use a modifier on the second chiropractic adjustment when this happens?

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Billing 98943 and 98941

Did Medicare pass a change on billing 98943 extremity adjustment with a 98941 manipulative adjustment?  Is the modifier 51 still required when billing with the 98941 manipulative adjustment?  Also, have all insurance companies accepting this change?

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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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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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