Chiropractic Coding - AAPC

1 11 Chiropractic CodingMichael D. Miscoe JD, CPC, CASCC, CUC, CCPC, CPCO, CHCC2 DisclaimerDISCLAIMERThis presentation is for general education purposes only. The information contained in these materials, lecture, ideas and concepts presented is not intended to be, and is not, legal advice or even particular business advice relevant to your personal circumstances. The laws, regulations and contractual terms regarding billing of any insurance as presented in this seminar are as published by the state or in relevant carrier policies/contracts and are open to interpretation.

2 It is your responsibility to evaluate relevant carrier medical policies and provider contract provisions as well as to seek private counsel with your attorney to determine how these laws, regulations, policies and contractual terms as well as the concepts discussed apply to your specific case before applying the concepts addressed in this seminar. Attendance at this presentation should not be construed as creating an attorney client relationship with the speaker nor should the information presented be construed as legal advice.

3 Remaining for this presentation indicates your acknowledgement and agreement with the Procedural Terminology (CPT ) is copyright 2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association (AMA).23 Webinar Outline Fundamental Coding rule Differentiating Chiropractic and osteopathic manipulation Proper evaluation of any therapy service Differentiating Modalities and Procedures Avoiding bundling traps and post payment liability associated with misuse of modifiers4 HIPAA Coding Standards Diagnosis -ICD-9-CM Including Guidelines Physician Services CPT /HCPCS Level II (no mention of guidelines) Official Comments: national codes are only designed to identify an item or service.

4 Codes are not established to carry health plan specific information must be used elsewhere and cannot be embedded in the national codes. health plans will have to receive and process all standard codes, without regard to local policies regarding reimbursement for certain conditions or procedures, coverage policies, or need for certain types of information that are part of a standard transaction. The Fundamental Coding Rule35 Usage Guidelines Applied in this Webinar AMA CPT Editorial Panel guidance Where is it? What does it include?

5 Codes Osteopathic Manipulative Treatment (98925-98929) Chiropractic Manipulative Treatment (98940-98943) Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes (97140)WHAT IS THE DIFFERENCE?47 CPT InstructionsIt is important to recognize that the listing of a service or procedure and its code number in a specific section of this book does not restrict its use to a specific specialty group. Any procedure or service in any section of this book may be used to designate the services rendered by any qualified physician or other qualified health care is Manipulation?

6 Commonly defined as causing movement of a joint into the para-physiologic range of motion without exceeding the boundaries of anatomic integrity. Physical Therapists call manipulation a Grade 5 Manipulation Osteopathic manipulative treatment (OMT) is a form of manual treatment applied by a physician to eliminate or alleviate somatic dysfunctionand related disorders. This treatment may be accomplished by a variety of techniques. Includes pre, intra, and post service E/M work necessary for performance of the manipulation. E/M can be billed separately where modifier 25 is When is that?

7 10 Chiropractic Manipulation Chiropractic manipulative treatment (CMT) is a form of manual treatment to influence joint and neurophysiological function. This treatment may be accomplished using a variety of techniques. Includes pre, intra, and post service E/M work necessary for performance of the manipulation. E/M can be billed separately where modifier 25 is justified .. When is that?611 Difference in Outcome? Somatic Dysfunction Somatic dysfunction is the impaired or altered function of bodily structures (most often of the musculoskeletal system, nervous system, or lymphatic system).

8 A term meaning an alteration in the normal function of a joint that has some effect in the body (soma). Disease or bodily organ system dysfunction that can be traced to a impaired or altered joint in Outcome? Joint and Neurophysiological Function Serving a neuromuscular reflex system, which drives the perceptual and reflex basis of posture, movement and respiration; of being a prime organ of equilibrium. The relationship between the position of a vertebral body, which impacts the afferent discharge from type I and type II corpuscular mechanoreceptors in the facet joint capsules, which produce reciprocally coordinated reflex effects on vertebral and limb musculature.

9 In short the impact of joint malposition on neurologic in Outcome? Chicken vs. the Egg Chiropractic Principles focus on restoring joint position to influence neurologic function on the premise that normal neurologic function will allow the body to effectively heal itself. The Osteopathic outlook simply looks to influence organ system function through correction of joint dysfunction (less stated emphasis on the neurologic component even though correction of the somatic problem relies on neurologic function).14 What About Manual Therapy?

10 Manual therapy, by CPT Description includes When should this code be used to report manipulation? Can physicians (MD/DO/DC) bill manipulation under this code? What About the CPT Instructions?815 Therapy Code Selection Fundamentals of Modality Coding Modality Definition: Any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical, or electric energy. Where Physical Agent Causes Change The Physical Agent Defines the Code Level of Contact REQUIRED Supervised/Constant Code Selection Fundamentals of Modality Coding Supervision: The application of a modality that does not require direct (one-on-one) patient contact by the provider.