Documenting Work-related Injuries in
Chiropractic Medical Billing
Workplace musculoskeletal injuries treated by a chiropractor can be reimbursed by submitting accurate medical claims to insurance companies.
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Phone: 1-800-670-2809
Workers are often exposed to different health hazards. Chiropractic care is considered a good option for work-related musculoskeletal conditions including back pain, carpal tunnel syndrome, headache and neck pain. According to a report published by the University of Maryland, more than one million back injuries are sustained in the workplace every year and these injuries account for one in every five injuries and illnesses at the workplace. Chiropractors or chiropractic physicians – practice a hands-on, drug-free approach to health care that
includes patient
examination,
accurate diagnosis and
treatment.
Proper
documentation is critical for the success of chiropractic medical billing. Clinical documentation is used by claims adjusters and insurance providers to determine the extent of medical coverage. Failure to adequately document an injury can severely limit a worker's legitimate access to care. Documentation must include a list of potential injuries and sources of pain, and detailed physical examination findings. In addition, accurate documentation can help control the rising workers' compensation costs by better conveying how an injury is related to work.
Accurate Diagnosis Crucial for Better Reimbursement Accurate diagnosis is critical to identify the exact condition of the patient and provide appropriate
treatment.
Chiropractors
assess
patients
through
clinical
examination,
laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate, and when it is not appropriate. The physician’s diagnosis represents the patient's condition to the insurance company and must be very accurate. For chiropractic services to be considered reimbursable, insurance companies are requiring that the diagnoses are valid and compatible with the CPT (procedure) codes, and substantiated by the physician’s documentation. Never assume the condition without a diagnostic test. However, payment for chiropractic services is limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist. Worker’s compensation usually fully covers employees’ chiropractic care if they experience an accident while on the job. Medical billing specialists use valid ICD-10 codes that facilitate authorization, claim payments and support the medical necessity of the service in case of review, audits or litigation. Codes must support neuromusculoskeletal (NMS) conditions, and represent the body regions requiring treatment.
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Phone: 1-800-670-2809
Here is a list of some ICD-10 codes applicable for the chiropractic specialty.
G56.03 Carpal tunnel syndrome, bilateral upper limbs
M25.50 Pain in unspecified joint (Sacroiliac joint)
M54.5 Low back pain
M54.12 Radiculopathy, cervical region
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M62.81 Muscle weakness (generalized)
M62.830 Muscle spasm of back
M75.01 Adhesive capsulitis of right shoulder
M75.02 Adhesive capsulitis of left shoulder
S76.011A Strain of muscle, fascia and tendon of right hip, initial encounter
S76.012A Strain of muscle, fascia and tendon of left hip, initial encounter
S13.4XXA Sprain of ligaments of cervical spine, initial encounter
S39.012A Strain of muscle, fascia and tendon of lower back
W10.0XXA Fall (on)(from) escalator, initial encounter
CPT Codes for Chiropractic Treatments CPT codes communicate uniform information about medical services and procedures to healthcare payers. These codes can be used to represent the various levels of chiropractic manipulative treatment. Spinal manipulation services are covered under the following CPT codes:
98940 (manipulation to one to two regions of the spine)
98941 (manipulation to three to four regions of the spine)
98942 (manipulation to five regions of the spine)
98943 Extraspinal, 1 or more regions
Each year CPT codes usually undergo certain revisions, updates and deletions. Chiropractors should be aware of these coding changes for an accurate medical billing and coding process. Professional physician billing services are now available to help chiropractors report the new codes, reduce error rates, achieve compliance and maximize revenue.
www.outsourcestrategies.com
Phone: 1-800-670-2809