Modifiers in Chiropractic Medical Billing

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Modifiers in Chiropractic Medical Billing
As per the recent study, it has been noticed that
Blue Cross and Blue Shield (BCBS) given denials
to chiropractic practices for the claims billed
with modifiers. Companies that offer medical
billing services identified that the majority of
the claims were denied owing to the requirement
of modifiers 25 and 59. According to the
Explanation of Benefits (EOBs), the modifiers
were utilized more than average or used
improperly. In December 2017, the Illinois
Chiropractic Society (ICS) announced that the
cases they studied, the modifiers, and procedure
codes were billed rightly as per the information
of claims, but because of a code-editing feature
introduced by BCBS claims were denied. This
incident has pointed to the importance of the
usage of modifiers for Chiropractic Medical
Billing. Proper utilization of modifiers can
escalate reimbursement. If codes are billed
without modifiers when it is required, the
carrier will deny the claim with justification on
the EOB of clubbing with another
service. Normally, an Evaluation and Management
service (E/M) is filed without a modifier.
According to the American Medical Association
(AMA), chiropractic manipulative treatment (CMT)
(98940-98943) is a type of manual service to
influence neurophysiological and joint function.
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Modifiers in Chiropractic Medical Billing
Modifiers in Chiropractic Medical
Billing Modifier 25 Modifier 25 is utilized to
show that this is an important, independently
recognizable evaluation and management (E/M)
service by the same physician on the same day.
Modification of the E/M doesnt assure you
the reimbursement. There are insurance companies
that wont cover CMT and E/M on the same day. On
the other hand, some will consider paying for a
new patient (99201-99205) not for an old patient
(99211-99215). Modifier 25 is only applicable to
E/M services. GA Modifier
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Modifiers in Chiropractic Medical Billing
This modifier suggests that the Advanced
Beneficiary Notice (ABN) is on file and enables
the provider to bill the patient if not covered
by Medicare. GY Modifier Added to all services
except the CMT for Medicare claims, as all
services excluding Chiropractic Adjustment are
not protected by the Medicare Program when
provided by a chiropractor. Modifier
59 Modifier 59 is utilized to show an important,
separately recognizable non-E/M service by the
same physician on the same day. Manual Therapy
Techniques (97140) used by chiropractors is a
common example of a non-E/M service. This
comprises manipulation/mobilization and manual
lymphatic drainage and manual traction-one area
or more, every 15 minutes. As this coding (97140)
involves modification, it can be updated with a
59-modifier if it is carried out on the same day
as a change (CMT). X-set Modifiers
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Modifiers in Chiropractic Medical Billing

• In January 2015, CMS published additional subsets
  of the 59-modifier, i.e. XE, XS, XP, and
  XU-modifiers that may be used instead of the
  59-modifier.
• XE Separate Encounter a service that is distinct
  because it occurred during a separate encounter
• XS Separate Structure a service that is distinct
  because it was performed on a separate
  organ/structure
• XP Separate Practitioner a service that is
  distinct because it was performed by a different
  practitioner
• XU Unusual Non-Overlapping Service the use of a
  service that is distinct because it does not
  overlap the usual components of the main service
• The Active Treatment (AT) Modifier
• The Active Treatment (AT) modifier was designed
  to define the difference between active treatment
  and maintenance treatment clearly. Medicare pays
  only for active therapy and does not pay for
  maintenance therapy.
• Claims should contain a primary diagnosis of
  subluxation and a secondary diagnosis that
  replicates the neuromusculoskeletal condition of
  the patient. These are some of the commonly used
  modifiers in chiropractic billing.

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Modifiers in Chiropractic Medical Billing
Medical Billers and Coders (MBC) is a renowned
medical billing service provider that can
effectively handle all your chiropractic medical
billing and Chiropractic Credentialing Service
needs and claim settlements. For more information
call us at 888-357-3226. Medical Billers and
Coders also have top Wound Care Medical
Billing and Orthopedic Medical Billing  RCM
Managers. FAQs 1. Why are modifiers important
in chiropractic billing?   Modifiers ensure
accurate coding for services rendered, helping to
prevent claim denials and maximize reimbursement
from insurance companies. 2. What is Modifier
25, and when should it be used? Modifier 25
indicates a separately identifiable E/M service
provided by the same physician on the same day,
but its use doesnt guarantee reimbursement,
especially for established patients. 3. What
does Modifier 59 signify in chiropractic
billing?
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Modifiers in Chiropractic Medical Billing
Modifier 59 is used to denote a distinct,
separately identifiable non-E/M service performed
by the same physician on the same day, such as
manual therapy techniques. 4. How do X-set
modifiers differ from Modifier 59? X-set
modifiers (XE, XP, XS, XU) offer more specific
designations for separate encounters or
structures, providing clearer distinctions for
services that may overlap or involve different
practitioners. 5. What is the purpose of the
Active Treatment (AT) modifier? The AT modifier
differentiates between active and maintenance
therapy in chiropractic care, as Medicare covers
only active therapy when treating conditions like
subluxation.