How to Bill Chiropractic prognosis Codes For Medicare

Hcfa 1500 Health Insurance Claim Form - How to Bill Chiropractic prognosis Codes For Medicare

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Billing chiropractic services for a Medicare inpatient can seem involved due to the estimate of rules that are exact to the chiropractic profession. In this article, we will focus on how to bill analysis codes correctly.

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Hcfa 1500 Health Insurance Claim Form

For chiropractic claims, since Medicare only covers spinal manipulation for the improvement of a subluxation, we must begin by having a analysis of subluxation in the first position (primary) of the analysis codes.

On a Hcfa claim form, this is Box 21D.

The only "approved" traditional analysis codes (Icd-9) that Medicare will accept for chiropractic claims are as follows:

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified
-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified
-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified
-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified
-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified
-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you "name" the diagnosis, these codes in the list above are the only traditional codes that apply to chiropractic services in the Medicare program.

The use of these codes does not warrant reimbursement, however, because the patient's medical narrative must document that Cms coverage criteria (medical necessity) has been met.

A big caution here, though. Failing to use these codes in the traditional (1st position) analysis will virtually warrant a Denial!

So, be sure to use the strict analysis codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!

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