Chiropractors, in-house billers, and medical billing services are very familiar with the procedure code 98941 and 98940.
98941 is used for a spinal manipulation of three (3) to four (4) areas.
98940 is also a chiropractic manipulation code, however it is used for one (1) to two (2) areas.
Many Chiropractic practices lose money by billing 98940 and 98941 incorrectly.
And since these claims initially are not sent out correct, rarely does the in-house billing staff have enough knowledge to correctly appeal the denied claims.
The end result is the provider will not be reimbursed for services they should be paid for.
Now, we will discuss the top 3 reasons why Chiropractic code 98941 and 98940 is denied.
Not Enough Regions Diagnosed 98941, is used when a Chiropractor adjusts three (3) or four (4) regions of the spine.
Many doctors encounter documentation problems as a result of using this code.
Each region that is being adjusted must have a diagnosis code.
Therefore, if the Chiropractor adjusts the cervical, thoracic and lumbar region of the spine, there must be corresponding regional diagnosis codes.
Each regional diagnosis code must also have a regional specific supporting code, as well.
For this reason, if you are manipulating three (3) areas of the spine your claim should have six (6) diagnosis codes.
Remember, proper documentation and proper diagnosis codes are imperative, if you want to be reimbursed for services rendered.
Missing the Supporting Code Medicare is a stickler for supporting codes.
Each region, in which a chiropractor adjusts, must have a primary diagnosis code, and a supporting code.
Both codes should diagnosis the same region of the body.
Therefore, if you have a primary cervical diagnosis code, the supporting code should also describe the cervical region of the body.
If Medicare receives a claim that has a primary diagnosis code, but has no supporting code the claim will be denied.
If Medicare receives a claim and the primary diagnosis code does not match the supporting code, the claim will be denied.
If the diagnosis codes are not listed in the right order, Medicare will deny your claim.
Documentation is the key when billing 98941.
Chiropractors MUST make sure that each region has a primary and supporting diagnosis, as well as, documentation to support the claims.
Missing Modifiers Modifiers are very important when sending 98941 to Medicare.
There are two main modifiers that you will use.
They are AT and the other is GA.
Some billers are unaware of when and how to use these modifiers.
The modifiers are used based on whether a patient has an x-ray date on file.
The x-ray date is important to Medicare because that is how they determine that the Chiropractor has taken the necessary steps to diagnosis and treat the patient.
If the Chiropractor does not have an x-ray on file within the last three months for the patient, then we have to make sure we use the correct modifier to indicate this on the claim.
If the correct modifier is not used, payment may be denied, delayed, or deducted.
If you are a Chiropractor, in-house medical biller, or one of the many medical billing services, you know that a lot of claims you send out to Medicare and commercial insurance companies will include 98941 or 98940.
Please remember to document, diagnose and don't forget your modifiers.
The truth is if claims are properly completed, 95% of all claims should come back paid.
The rest of the 5% can be appealed.
If you are not hitting those numbers, I can assure you that you are making one of the above mistakes.