Healthcare Blog

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New Legislation Aims to Improve Medicare Chiropractic Documentation

New legislation was introduced earlier this month that calls for the Secretary of Health and Human Services to develop an education program intended to help improve documentation in chiropractic Medicare claims, according to an American Chiropractic Association news release.

The bill — called the "Protecting the Integrity of Medicare Act of 2014" (pdf) — was introduced by U.S. House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA).

According to ACA, the bill would subject chiropractors to pre-authorization standards, established by HHS, if their claim denial rates were notably out of line with the rest of the profession. Chiropractors who have a good record of claims (low denial rate) based on proper documentation and those who are willing to participate in the education program would avoid pre-authorization requirements that non-compliant providers could eventually face.

According to the bill, the program would be developed "in consultation with stakeholders (including the ACA) and representatives of Medicare administrative contractors," with educational and training programs designed to improve the ability of chiropractors to provide documentation publicly available no later than January 1, 2016.

You can learn more about chiropractic documentation requirements on the ACA website at

Chiropractors with questions about denials, documentation and other billing challenges should contact PGM Billing, one of the nation's leading chiropractic billing companies. PGM has more than 30 years of experience providing chiropractic billing services. Its team of certified coders and billers can manage all aspects of chiropractic billing to help ensure practices receive proper compensation for services.

Coding Guidance for Smoking Cessation Counseling

The American Psychiatric Association provides a two-page resource discussing procedure coding for smoking cessation counseling.

There are a number of different procedure codes that can be used to describe services provided to encourage changes in behavior of individuals who use tobacco.

The resource identifies the CPT and HCPCS codes that describe smoking/tobacco cessation counseling, as well as reporting requirements.

It is important to note that coverage of individual codes by Medicare differs from that of commercial payers, which is dependent on individual payer policy.

Access the APA's article on smoking cessation counseling coding (pdf).

For more information, you can view the MLN Matters article on "Counseling to Prevent Tobacco Use" (pdf).

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