Chiropractic Documentation Articles and Resources
News and Important Information
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
Auditing Chiropractic Services
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May 30th, 2023
Understanding, Identifying, and Reporting Combination Codes
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Coders often see conditions that seem to always be reported together. Diabetic patients tend to develop other conditions as the diabetes continues to progress instead of improving. Combination codes are one of those types of codes that identify multiple conditions or diseases but have their own set of special coding guidelines.
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.
Oct 4th, 2021
Watch out for New ICD-10-CM Codes
by Wyn Staheli, Director of Content - innoviHealth
New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.
Mar 18th, 2021
How Reporting E/M Based on Time May Lose Money
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ...
Apr 20th, 2020
Dismal OIG Report on Telemedicine
by Wyn Staheli, Director of Content - innoviHealth
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Question:
What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms.
Answer:
There is no question that these adjustments would be considered ...
by Wyn Staheli, Director of Content - innoviHealth
The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ...
Jun 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
Jun 6th, 2019
How to Code Ophthalmologic Services Accurately
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
Apr 23rd, 2019
Let's Talk High Risk E/M Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
Apr 22nd, 2019
Auditing Chiropractic Services
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
Mar 21st, 2019
The Impact of Medical Necessity on High Level E/M Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
Mar 1st, 2019
Understanding NCCI Edits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Feb 12th, 2019
Coding Medicare Initial Preventive Physical Exams (IPPE)
by Aubrie Rowley
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
Jan 25th, 2019
Medical Necessity vs. Documentation for Inpatient Services
by NAMAS
Auditing the documentation of inpatient and observation E/M services can often be challenging. Many of the notes we are provided for review include so much information that the note feels like a short novel instead of documentation for one date of service. This over-documentation can make it difficult to see ...
There are 36 related documentation, coding and billing tips.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Sep 5th, 2023
Modalities Used in Your Chiropractic Office
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Electrical stimulation, ultrasound, and mechanical traction are modalities commonly used in chiropractic offices. And they are commonly documented incorrectly or billed improperly. Learn the right (and wrong) ways to get paid for these kinds of services. Join Dr. Evan Gwilliam, certified coder, and all-around nice guy, as he answers your most burning questions about the CPT codes 97012, 97014/G0283, 97032, and 97035.by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
'Reduce pain" may be a real goal of chiropractic care, but is it enough? While you may want to help your patients to reduce their pain, goals need to focus on what kinds of functions are affected by that pain. Does it keep the patient from sleeping, from sitting at a desk, from washing their hair when in the shower? Learn how to create goals that are easy to defend and use to justify ongoing treatment in this fun-filled webinar by Dr. Evan Gwilliam, a Certified Professional Medical Auditor.Feb 14th, 2023
Use the Right Modifiers for Chiropractic Billing
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Do you really know when to use the 59 modifier? What about the AT? There are relatively few modifiers to consider when it comes to chiropractic billing and coding, but some payers have their own rules and it can be tricky to know when to use one modifier and not another. In this exciting webinar, Dr. Evan Gwilliam, a certified coder, will clear up all the questions you have about the modifiers you need to consider.Jan 25th, 2023
Medical Necessity: it’s far easier to prove than you think, and far more important than you realize.
by Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education
Besides coding errors, it’s the 2nd most common tool used by health insurers and 3rd party payers to deny care and deny liability. How do you decide what to use as a tool to prove your care is viable and needed? Expensive equipment and elaborate testing procedures are not what you need. It’s as simple to prove as opening a can of beans, unless you don’t have a can opener. I’ll share with you my insider tips and experience as a medical expert on over 3000 successful PI case settlements and give the can opener that you and your patients need you to use to prove medical necessity, and why you’ll need it in treating what I feel is the next great opportunity for Chiropractic: V_______ care.Aug 16th, 2022
Medicare and the ABN for Chiropractic
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Medicare can be intimidating, but fortunately, the rules can be made simple and actually reduce anxiety when applied properly. All you need to know about ABNs and Medicare modifiers will all be covered in this presentation so that you can feel confident you know you are doing things right.by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Anyone who sees patients who have services that are not covered by insurance needs to know about the No Surprises Act. In this quick webinar, Dr. Gwilliam will show you how to properly notify patients of their options and create a Good Faith Estimate, as required by this law. Expect this…Feb 8th, 2022
Medicare Audit, Do-it-yourself
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Don't wait for Medicare to look over your records and try to find deficiencies. Dr. Gwilliam, a Certified Professional Medical Auditor, will show you how to find your own deficiencies, and fix them before they become a compliance or financial concern. This isn't just for Medicare either. If you can…Jan 11th, 2022
Chiropractic Documentation: The Subjective Element
by Ron Short, DC MCS-P CPC
The Subjective element of S.O.A.P. is where we document what the patient tells us. But what is the best way to gather this information? In this webinar Dr. Ron Short will review the guidelines for the subjective element and explain the best way to gather information from the patient.&…by Ron Short, DC MCS-P CPC
We have all heard of the S.O.A.P. format for our documentation. But what does each element mean and what additional information do we need in our documentation? In this webinar Dr. Ron Short will review the S.O.A.P. documentation format and discuss what additional information you need document. In…by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
The most commonly used procedure in chiropractic is the chiropractic adjustment, also known as chiropractic manipulative treatment or CMT. There are nuances to the CPT and ICD-10 codes and Medicare guidelines that must be mastered by any chiropractor hoping to find success when creating their…Jul 8th, 2021
Chiropractic Treatment Paradigm 2021
by Ron Short, DC MCS-P CPC
Chiropractic care is different from medical care. We know that but how do we explain it. Reviewers deny claims that are medically necessary because they don’t know what they are looking at when they review our claims. Dr. Ron Short will explain how to approach these reviewers in this…by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
August 18, 2020 Join this webinar for a birds-eye review of crucial components of your practice revenue cycle system. Inefficient or unattended revenue cycle systems result in a tremendous loss of time and money for practices. So often, that additional cash flow that practices are seeking, are…Jan 7th, 2020
Rock Solid Care Plans
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Don't ever let anyone challenge your care plans ever again. If you can know what the regulators are looking for while still being free to deliver the care you deem to be best for your patient, then you win. And your patient wins. Join Dr. Gwilliam, certified professional medical auditor, and all around nice guy, as he guides you to the steps to create rock solid care plans that will stand up to third party scrutiny.Nov 5th, 2019
Proving Medical Necessity and Functional Improvement
by Ron Short, DC MCS-P CPC
Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement.by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
The most used codes in chiropractic are 98940, 98941, 98942, and 98943. In this webinar, Dr. Gwilliam will go over the fundamentals of these codes and make sure you are proficient with them. They probably play a bigger part of your practice than any other code, so it is worth it to make sure you are reporting them correctly. By the end of this presentation you will be able to diagnose, document, and code properly for CMT, as well as avoid common mistakes.Mar 29th, 2018
Coding and Auditing TeleHealth Services
by Find-A-Code™
Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.Links and resources by topic.
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