Chiropractic
Correct Coding on Claims: Due to recent denials some providers experienced on CPT code 98941 (Chiropractic manipulative treatment-CMT-spinal, 3-4 regions) PrimeWest Health would like to clarify our requirements when billing for multiple region treatment.
The denial, EX64-procedure inconsistent with diagnosis, has been recently issued on claims that were submitted with 98941 (3-4 regions treated), with a corresponding diagnosis code for only one region of subluxation. Example: 98941 with diagnosis codes 739.1 (Nonallopathic lesions, NEC Cervical Region) is not considered correct coding because the diagnosis code includes only one region of subluxation, whereas the CPT code is for treating 3-4 regions. At a minimum, there should be 3 regions of ICD-9-CM diagnosis codes to correspond with the 3-4 regions of the CPT code.
Chapter 18 of the PrimeWest Health manual states: "Providers must submit the most applicable diagnosis codes ICD-9-CM when billing for subluxation on claims". We are currently updating our manual to include a more in-depth explanation of this process. The appropriate diagnoses should always be submitted for each service. However, because these edits to the claims were not previously in place and claims were accepted with only one regional diagnosis, we felt it would be beneficial to provide more detail for correct coding.
The new coding guideline will state that providers must choose all applicable subluxation ICD-9-CM code(s) to identify the area(s) of subluxation. This guideline affects CPT codes 98940 and 98942 in addition to 98941. Listing all applicable diagnoses will confirm the medical necesseity for treatment provided.
1-2 manipulations: When billing 98940, report the first subluxation in Item 21, position 1. Any additional subluxation should be listed in Item 21, position 2.
3 or more manipulations: When billing codes 98941 or 98942, report the first subluxation in Item 21, position 1. Up to 3 additional subluxations should be listed in Item 21 positions 2-4. Any additional subluxations should be listed with a written description, in Item 19. Effective August 10, 2008 claims that do not follow these guidelines will be denied with denial code EX64.(06/26/08)
Acupuncture: Acupuncture is covered for chronic pain. Authorization is required in excess of 10 sessions and must be performed by: 1) an MD or licensed acupuncturist employed and supervised by an MD; or 2) provided through a hospital pain management program by an MD or licensed acupuncturist who is supervised by an MD. Use the physician extender modifier for non-physician services. (10/1/07)