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Welcome to ChiroCode
Q/A: Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
Published November 19, 2019
By Wyn Staheli, Director of Research
Question:
How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
Answer:
In one word — modifiers. Modifiers are the best way to communicate this information to the payer. As an example, if the patient’s primary payer was Medicare and you know that their secondary policy covers a service that Medicare does NOT cover when provided in a chiropractic office (e.g., electrical stimulation, x-ray), then you would include modifier GY to indicate that it is a noncovered service. Keep in mind that there may be other modifiers which would also need to be added to the procedure code on the claim (e.g., GP, GX).
Note: Please see “Medicare Modifiers” beginning on page 115 of the 2020 ChiroCode DeskBook for more comprehensive information on using these modifiers.
Calculate fees for your area. Please enter your zip code.
About This Tool
The Basic Medicare Fee Calculator is a helpful tool which uses Resource Based Relative Value Units (RBRVS) to estimate fees. It is only for educational purposes and should not be used as your only source for fee schedule determinations. The percentages included here should only be used as a reference and should be adjusted to fit your individual needs. Please note that some states, such as Florida, mandate specific percentages of the Medicare Fee as the allowed amount for personal injury or other claims.
Instructions
Enter your zip code and click on the [Create Fee Worksheet] button. Geographic adjustments will be applied to the displayed Medicare Fee. The Medicare Fee displayed is the Allowed Amount. To find the Medicare limiting charge for non-participating providers, consult your Medicare Administrative Contractor.
Disclaimer
By providing this tool, ChiroCode does not guarantee or assure correct use and application of fees and or codes to users or any other party. Reasonable effort has been made to verify the accuracy of this tool. The regional Medicare fees used as a foundation for this tool are believed to be accurate and current. Absolute accuracy though of this tool or the use of this tool cannot be guaranteed. ChiroCode will be held harmless of any and all liability arising from fee schedule establishment or management based upon the use of this tool. This tool is not endorsed by the American Medical Association (AMA).
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Find-A-CodeFind-A-Code is dedicated to providing the most complete medical coding and billing resource library available anywhere. Find-A-Code's online libraries include extensive information for all major code sets along with a wealth of supplemental information. |
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For over 25 years, ChiroCode has led the way in helping the chiropractic profession with coding and reimbursement issues. Our mission is to help chiropractors and their staff get the information they need to run a successful and compliant practice.
Our flagship product, the annual ChiroCode DeskBook, contains the essential codes and other information you need to assist with proper coding and compliance. ChiroCode's products focus on the following areas:
Documentation
Patient documentation is the foundation of every patient visit in chiropractic practices. It establishes and supports the need for patient care. It is also one of the most highly cited problems by the OIG. Providers must have thorough documentation that adequately meets medical necessity requirements in order to receive and keep third-party reimbursement. Documentation requirements can seem daunting. However, with the help of ChiroCode, documenting correctly for new and established patient visits, consultations, daily visits, therapies, and products supplies can become more clearly understood and more efficient.
Coding
Coding includes the CPT, HCPCS, and ICD-10-CM code sets that chiropractic and other medical providers are required to use to communicate patient procedures, symptoms, and conditions. Coding tends to be an area of uncertainty in chiropractic which can lead to erroneous code selection which can in turn lead to provider vulnerability. ChiroCode is an industry leader in coding compliance and provides valuable resources to build practice confidence in coding.
Reimbursement
Reimbursement for services rendered should be a consistent, organized, efficient, and predictable cycle in every practice. The health of a practice depends on it. Reimbursement may include: patient collections, insurance billing, patient billing, accounts receivable management, management of claims follow-up, appeals and resubmissions. ChiroCode understands the complexity of all parts of the reimbursement cycle as well as the need for proper systems and the ability for a provider/owner to monitor this department and reduce provider risk.
Compliance
Medical practices are under increased scrutiny for healthcare fraud and abuse. Provider compliance programs are mandated by the Patient Protection and Affordable Care Act of 2010. Sound compliance plans must be implemented and carefully followed in order to protect your organization. Chirocode helps providers minimize risk by addressing the various levels of compliance, including HIPAA, OIG (Office of Inspector General), and OSHA.
