Chiropractic physicians are also known as wellness physicians. Insurance companies and patients are still jumbling through different contracts to pay wellness physicians. At Medical Billers and Coders (MBC) we cater to the requirement of more than 70 chiropractic physicians. Each physician has different requirements based upon the demography, payer contract, and patient care. Billers and Coders have to systemize the claim generation and submission according to the regulation and requirements.
“The requirements keep differencing as the patient change, so we stay flexible with the payment schedule. An update is usually done through a series of questions which makes sure we don’t miss out on any criteria. The challenge is to keep the claim error-free.” informed a biller.
Tips to go through for Chiropractic Billers and Coders:
Preventive Evaluation and Management for New Patients
A comprehensive preventive medicine evaluation and management of a patient inculcating different age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient;
99381: infant (age younger than 1 year)
99382: early childhood age (age 1 through 4 years)
99383: late childhood age (age 5 through 11 years)
99384: adolescent age (age 12 through 17 years)
99385: 18-39 years
99386: 40-64 years
99387: 65 years and over
Preventive Evaluation and Management for old Patients
Preventive medicine reevaluation and management of an individual.
99391: infant (age younger than 1 year)
99392: early childhood age (age 1 through 4 years)
99393: late childhood age (age 5 through 11 years)
99394: adolescent age (age 12 through 17 years)
99395: 18-39 years
99396: 40-64 years
99397: 65 years and over
Codes 99381-99397 are covered by most insurance plans when performed by an MD/DO – these codes are not covered by Medicare.
Initial Preventive Physical Examination (IPPE) for initial chiropractic patients in Medicare
This is a “Once-in-a-lifetime” covered under the Medicare benefit. This includes different lab tests to check the patient health. Use HCPCS code G0402 for the initial preventive physical exam. This is a face-to-face visit and the beneficiaries can avail of this during the first 12 months of Medicare enrollment.
Medicare Annual Wellness Visits (AWV)
The AWV from Medicare includes the establishment of or update to, family history and health features. The goal is health promotion and diseases prevention, however, clinical lab tests are not included. AWV is not a routine medical test and Medicare won’t pay for regular physicals.
Use HCPCS code G0438 for the initial AWV. This includes a personalized prevention plan of service. This service is covered one time in the 2nd year of eligibility. Co-pay, co-insurance, and deductible waived.
Use HCPCS code G0439 for the subsequent AWV. This includes a personalized prevention plan of service. This service is covered one year after the initial AWV. It does not include lab tests. Co-pay, co-insurance, and deductible waived.
Physical or Manipulative Therapy Performed for Maintenance rather than Restoration:
Use HCPCS code S8990, except when billing Medicare. Code S8990 can be used for chiropractic adjustments once the patient has reached maximum therapeutic benefit and has transitioned to preventive/wellness care or performance-enhancing care.
To know more about our chiropractic billing and coding services, get in touch with us!
FAQs
1. Why is chiropractic billing and coding so complex?
Chiropractic billing involves various patient demographics, payer contracts, and specific insurance requirements. Billers must stay flexible and adapt to different guidelines to ensure accurate claims submission.
2. What are the key preventive evaluation codes for new patients?
Codes like 99381-99387 are used for preventive evaluations based on the patient’s age group, ranging from infants to seniors. These evaluations include history-taking, physical exams, and preventive interventions.
3. What should I know about Medicare’s Annual Wellness Visits (AWV)?
Medicare covers two types of AWVs: the initial visit (HCPCS code G0438) and the subsequent visit (HCPCS code G0439). Both focus on health promotion and disease prevention but do not include lab tests.
4. What is the Initial Preventive Physical Examination (IPPE) under Medicare?
The IPPE (HCPCS code G0402) is a “once-in-a-lifetime” service for new Medicare patients, including various lab tests and assessments, offered within the first 12 months of Medicare enrollment.
5. How do I bill for maintenance chiropractic care?
For maintenance chiropractic therapy after a patient reaches maximum therapeutic benefit, use HCPCS code S8990. However, this code is not applicable when billing Medicare.
