We are using the ABN for non-covered services (such as therapy codes) when the patient is under active care. We are also using the ABN for CMT codes when the patient is under maintenance care. We are now confused about when to use the modifiers GA & GY when billing CMT & therapy codes. Would you please explain when & why each should be used for Active and Maintenance Care?
Watch Another quick tip from the ChiroCode HelpDesk – Plain Film Xray Penalty 2017. Even though this news comes from Medicare, who does not reimburse chiropractic physicians for x-rays, private payers nearly always follow their example. This represents the trend of X-ray reimbursement for all of healthcare.
Q: If a patient is treated with chiropractic manipulation and it is clinically appropriate but doesn’t qualify as medically necessary care, what is the proper way to communicate this when billing the insurance company for the service?
What do you do when you are continually getting denials when billing office visit E/M code 99213-25 along with a CMT on dates that we do re-exams? What do you do when an appeal does not seem to work even though clear evidence has been provided that all conditions for the 99213 have been satisfied.?
Modifiers are two-digit codes appended to procedure codes and/or HCPCS codes to provide additional information about the billed procedure. In some cases, addition of a modifier may directly affect payment and incorrect use can result in audits and potential recoupment. In this webinar, certified coder and auditor David Klein will review the “do’s” and “don’ts” of proper modifier usage to help maximize reimbursement and reduce the likelihood of an audit.
Telehealth and telemedicine are covered for many payers for services such as consultation, office visits, individual psychotherapy, and pharmacologic management delivered via a telecommunications system.
97110, Therapeutic Exercises, is one of the most commonly used CPT codes for Chiropractors. Unfortunately it is also misunderstood and misused far too often. For instance, did you know that it should not be reported with modifier 52, ever? Find out all you need to know about this code in the 2016 ChiroCode DeskBook Common Procedure Codes chapter.
Some doctors fail to code properly for a temporary doctor who is covering an office, or for mutual coverage with a colleague.
It is a common practice for doctors in solo practice to find someone to “cover” for them while they are away from the office for a temporary or extended period of time.
During such …
Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
Documentation indicates the services were provided during separate patient/provider encounter
Use Modifier XE with the Column 2 procedure code in the NCCI files
Use Modifier XE only when there …
Audits are on the rise and the last you want to do is get tangled up in a fight over money you have already been paid. A smart chiropractor will audit himself to make sure there is little for the insurance companies to find when they strike.