There are nearly 11,000 CPT codes to account for all the different variations of healthcare treatments. While your chiropractic practice will only need a fraction of these codes, it’s vital that the chiropractic CPT codes are current and accurately reflect the services rendered.
If you’re utilizing chiropractic CPT codes that aren’t appropriate or are keyed incorrectly, your reimbursements can be delayed or your claims can be rejected. In any case, this will disrupt your overall revenue cycle.
Since the CPT codes are updated to some degree every year, let’s review the new changes and essential codes for your chiropractic practice!
New Chiropractic CPT Codes and Changes for 2023
All chiropractic services rendered in 2023 must align with the patient’s condition and can only be billed if they are reasonably and medically needed.
Along with this, you’ll only bill for direct services provided to patients – care and treatment provided by the patient, unskilled assistant, or office technician without the supervision of a licensed provider won’t be recognized as professional therapy.
A majority of the CPT codes that were updated or revised for 2023 deal with simplifying the language used for evaluation/management (E/M) codes for:
- Inpatient and observation care services
- Consultations
- Emergency department services
- Nursing facilities
- Home and residence services
- Prolonged services.
The American Medical Association (AMA) has more details regarding the changes for these categories of care, but some highlights include:
- Editorial revisions to the code descriptors to reflect the structure of total time on the date of the encounter or level of medical decision-making when selecting code level for inpatient and observation care services
- Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of Medical Decision Making (MDM)
- Revision to nursing facility guidelines with new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care
- The domiciliary or rest home CPT codes (99334-99340) were deleted and merged with the existing home visit CPT codes (99341-99350)
- A new code (993X0) was created to be analogous to the office visit prolonged services code (99417); this new code is to be used with the inpatient or observation or nursing facility services
Essential Chiropractic CPT Codes and Modifiers for 2023
While there are numerous chiropractic CPT codes, there are four main CPT codes chiropractors use for reimbursements; each code represents a specific region of the spine that was treated. These main codes are as follows:
- 98940: Used for the examination, diagnosis, and manipulative treatment of one to two spinal regions
- 98941: Used for the examination, diagnosis, and manipulative treatment involving three or four spinal regions
- 98942: Used for the examination, diagnosis, and manipulative treatment involving five or more spinal regions
- 98943: Used to report chiropractic manipulation of one or more of the extra-spinal regions
There are additional two chiropractor modifier codes commonly used. These can be attached to certain CPT codes to tell insurance providers that some of the treatments the CPT code describes were slightly altered.
If your selected CPT code requires a modifier but you fail to include it, your claim will likely be denied by the insurance company:
- Modifier 25: This Modifier is used to report a significant and separately identifiable Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional
- Modifier 59: Use this Modifier to report a procedure or service that was distinct or independent from other non-E/M services performed on the same day
When billing for these chiropractic CPT codes, remember these points:
- Report the initial treatment procedure
- Report the date of the X-ray if it was applied, including the X-ray film
- If an X-ray is unavailable, a physician’s examination may be used to document subluxation. The physical examination record must reflect the subluxation.
- Report subluxation using the recommended ICD-10-CM code
- All treatment procedures should be categorized as maintenance therapy, chronic subluxation, or acute subluxation
Direct Patient-Chiropractor Care CPT Codes
When billing for chiropractic care, you can only quantify the time that is spent with direct patient-chiropractor care; the client waiting for equipment or resting in your office doesn’t qualify as direct care, so it can’t be billed.
Refer to these ranges of chiropractic CPT codes to find the one that is most appropriate for chiropractic services rendered:
- 97032-97039
- 97530-97546
- 97110-97150
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