How Chiropractic Medical Billing is Different

What are the basics and special needs of chiropractic medical billing? Find out here...

Ten years ago, insurance companies didn't cover chiropractic services, because they thought the treatments unnecessary and experimental.

Nowadays, however, chiropractic services are more commonplace. Many insurance plans cover a certain number of chiropractic services per person per plan year.

So chiropractic medical billing specialists are needed to fill out medical claims forms, complete with diagnosis and procedure codes, and send them to insurance companies for payment. Just like any other medical claim.

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There are lots of restrictions on chiropractors because their services are so specialized. As such, there's a very specific set of codes that chiropractic medical billing specialists can use.

The following guidelines are set forth by CMS, and are used for billing Medicare. If you're billing for other commercial insurance plans, there may not be as many restrictions as those listed here.

Coverage restrictions

If chiropractic claims aren't billed correctly (with documentation of medical necessity) then they won't be considered or paid for by the patient's insurance company.

Perhaps the biggest restrictions are the coverage limitations. Insurance coverage of chiropractic treatments only extends to treatment of the spine by manual manipulation, to correct a subluxation of one of the vertebral joints.

If the chiropractor uses an x-ray or other diagnostic service to find and diagnose the subluxation, the x-ray or exam can be used for further documentation.

However, insurance won't reimburse for the use of an x-ray machine or for the extended examination.

All other services that the chiropractor provides are considered non-covered by Medicare, which sets the precedent for many commercial insurance companies.

This means that anything performed by the chiropractor, other than the spinal manipulation, won't be paid by the patient's insurance company.

Manual manipulation

Only services referred to as manual manipulation are covered by insurance.

More specifically, this is limited to the use of hands to correct a subluxation of the spine. In other words, the chiropractor uses his hands to help realign the patient's spinal column.

Manual devices which provide an additional thrust or force are also allowed as part of the covered definition of manual manipulation. Even though they're allowed, CMS doesn't allow an additional payment for the use of the device.

Sometimes, the word correction is used in place of treatment. Both are covered if they're part of the manual manipulation. Here are some other terms that indicate manual manipulation:

• Spinal adjustment by manual means
• Spinal manipulation
• Adjusted manually
• Vertebral manipulation/adjustment

Subluxation

To understand how to bill chiropractic medical billing claims, you have to understand the vocabulary.

In other words, your back is out of place. This spinal maladjustment can cause many symptoms, including:

• pain
• dizziness
• vertigo
• nausea
• numbness
• and poor posture.

In order to get reimbursed by insurance for chiropractic services, the exact location of the subluxation must be clearly noted in the patient's medical chart. These locations range from the occiput vertebrae in the neck to the sacral vertebrae and coccyx.

You can specify the subluxation by referring to the exact bones that are out of place, or by referring to a certain area or set of vertebrae that are out of place.

There are also other terms that also indicate subluxation, including:

• Misaligned
• Off-center
• Malpositioned
• Rotated
• Abnormal/altered/decreased/increased spacing
• Incomplete dislocation
• Aberrant/hypo-mobile/limited/lost/restricted motion

Physical examination: PART

To demonstrate a subluxation by physical exam, there are four criteria to choose from:

• Pain/tenderness in a specific location, of a certain quality, or of a certain intensity
• Asymmetry/misalignment of a sectional of segmental level
• Range of motion abnormality
• Tissue or tone changes in soft tissue

The patient must demonstrate at least two of these four symptoms. One always has to be either asymmetry/misaligned or range of motion abnormality.

These four factors (acronym PART) are the basis of all chiropractic physical exams.

Treatment Necessity

In addition to the stringent demands set forth by the physical exam and description of the subluxation, there are two other criteria that must be met in order for chiropractic services to be covered. They are:

• The patient must have a significant health problem which makes it necessary for the chiropractor to use musculoskeletal manipulation as a therapeutic remedy

- and -

• The patient must have a spinal subluxation, as determined by the physical examination or x-ray.

If both of these conditions aren't met, then the chiropractic services won't be covered.

Further rules and guidelines

CMS goes on to include many more rules and guidelines which determine whether or not chiropractic services will be paid for.

Example: chiropractic maintenance therapy, for the prolonged maintenance of a subluxation or for non-medically necessary therapeutic use, isn't covered in any circumstance.

There are also further guidelines for the use of dynamic thrust (the technique used by most chiropractors to correct subluxations), and the frequency of chiropractic manipulations.

Additional guidelines are the usual medical billing and coding guidelines used for billing typical medical services.

Understanding the basics of chiropractic medical billing may help you decide on your billing specialty.

Perhaps you'll like the small set of specialized services provided by chiropractic offices. The detail-oriented and skilled chiropractic medical billing techniques might suit you better than regular, expansive medical billing.

Interested in this specialty? See our guide to chiropractic medical billing software.

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