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Jo-Anne Q Chiropractic versus Medical Coding recently switched from coding & billing with a 975 collection rate to billing for a chiropractic group Now 50 of my claims are being denied — particularly with Medicare, and I'm not doing anything differently than I did at my prior job A Chiropractic billing is very different from medical billing for a physician and the most important task at hand is to research each payer rule for chiropractic and that goes for other specialties too like podiatry and so forth There are limitations with some specialties Coding should not be an issue with this specialty, but knowledge of the guidelines is imperative Many health insurance plans do not offer chiropractic benefits and other plans offer this as an additional coverage for a fee for patients but please note that anyone on Medicare has stringent guidelines and offers minimal coverage for services provided What does Medicare pay for Chiropractic care has limited coverage Medicare covers manipulations only of the spine if medically necessary to correct a subluxation Office visits are not covered X-Rays are not covered Manipulation of extremities hands and fee tare not covered A subluxation which is an incomplete or partial dislocation of the vertebrae must be the primary diagnosis always followed by a secondary neuromusculoskeletalcondition The subluxation must be demonstrated in the patient documentation in the event of an audit, and it buys either an x-ray or a physical exam and the specific vertebrae must be documented Chiropractic manipulation codes must be appended with a modifier AT to indicate the care is active or corrective Omission of this modifier will result in an automatic denial with no patient responsibility That's very important, but again this is Medicare and if you're not using that modifier, or you're billing for an office visit like you would for a doctor or medical doctor that's why your collections are so poor because its just very specific rules On the CMS-1500 Form block 14 must have date and not necessarily a date of injury or first symptom but the date of the first visit for the current episode If the patient just came in that day to starter treatments that would be the date of service Block 19 must indicate an x-ray date if there was an x-ray taken and used to identify the subluxation There were only three codes that Medicare accepts for billing and that's the 98940 which is 1-2 regions 98941 3-4 regions of the spine and 98942 for 5 regions of the spine If you look in the CPT manual you'll actually see a 98943 for extremities because I'm talking about Medicare those are the only three that are accepted As far as Advanced Beneficiary Notices all other services the chiropractic with Medicare such as exams x-rays therapies are not statutorily covered services when performed by a chiropractor, so you're not required to give your patients an ABN to sign If a doctor a chiropractic who gives outran ABN is strictly voluntary and all the rules...