Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has published three new MLN Matters special edition articles for chiropractors and other practitioners who submit claims to Medicare Administrative Contractors (MACs) for chiropractic services provided to Medicare beneficiaries.

MLN Matters SE1601 is titled "Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits." Topics covered include the following:  

  • Documentation requirements for the initial visit
  • Documentation requirements for subsequent visits
  • Necessity for treatment of acute and chronic subluxation
  • ICD-10 codes that support medical necessity for chiropractor services

MLN Matters SE1602 is titled "Use of the AT modifier for Chiropractic Billing," an accompanying article to MM3449 on "Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy, Full Replacement of CR306."

The key point in SE1602 is that for Medicare purposes, a chiropractor must place an -AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the -AT modifier may not in all instances indicate that the service is reasonable and necessary. As always, MACs may deny if appropriate after medical review determines that the medical record does not support active/corrective treatment.

MLN Matters SE1603 is titled "Educational Resources to Assist Chiropractors with Medicare Billing." Topics covered include the following:

  • Enrollment information
  • Coverage, documentation and billing
  • Advanced beneficiary notice (ABN) information

For assistance with chiropractic billing, contact PGM Billing, a leading provider of practice management services, including electronic and paper claims filing; claim adjudication; patient and insurance payment posting; patient invoicing, collection and inquiries; and form development.

The Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) have announced they will add about 1,900 diagnosis codes and more than 3,600 hospital inpatient procedure codes to the ICD-10 coding system for claims in FY 2017.

To access the new procedure coding system codes, visit the CMS website.

The new diagnosis codes will be included in the hospital inpatient prospective payment system (IPPS) proposed rule for FY 2017. It is expected to be released next month.

The American Hospital Association, in AHA News Now, indicated that, "The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015."

Summary of ICD-10-PCS Updates

According to the agenda from a recent ICD-10 Coordination and Maintenance Committee meeting, there are a total of 75,625 valid ICD-10-PCS codes for the FY 2017 update as of March 9. This includes 3,651 new codes which will be added, and 487 code titles which will be revised.

Of the codes added, 3,549 new codes (97% of the total update) are cardiovascular system codes. Of the new cardiovascular system codes, 3,084 new codes (84% of the total update) resulted from a group of proposals to create unique device values for multiple intraluminal devices and to apply the qualifier bifurcation to multiple root operation tables for all artery body part values.

Other cardiovascular system proposals include more specific body part values for the thoracic aorta, specific table values that uniquely capture congenital cardiac procedures, and codes involving placement of an intravascular neurostimulator.

All code titles revised are in the heart and great vessels body system, and result from changing coronary artery number of sites to specify number of vessels, and modifying the previously non-specific thoracic aorta body part to specify descending thoracic aorta.

Other proposals that resulted in new codes are in the lower joint body systems, for expanding the body part detail available in the root operations removal and revision, and adding unique codes for unicondylar knee replacement.

There are also new codes for intracranial administration of substances (such as the Gliadel chemotherapy wafer) using an open approach. There are planned new codes for face transplant, hand transplant and donor organ perfusion.

Summary of Diagnosis Codes Updates

A summary report of the diagnosis part of the March 10 ICD-10 Coordination and Maintenance Committee meeting report is not yet available. To view the CDC diagnosis agenda, which discusses diagnosis codes changes, click here.

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