Chiropractic Billing ICD 9 Codes For Medicare

Billing chiropractic services for a Medicare patient can seem complicated due to the number of rules that are specific to the chiropractic profession.

In this article, we will focus on correct and effective Medical Billing and Coding of Chiropractic ICD 9 diagnosis codes for Chiropractors.

Each service/procedure billed for a patient should be supported by a diagnosis that would substantiate those particular services or procedures, as necessary in the investigation or treatment of their condition, based on currently accepted standards of practice by the chiropractic profession.

For chiropractic claims, Medicare only covers spinal manipulation for the correction of a subluxation. Therefore, chiropractic coding must begin by having a diagnosis of subluxation in the first position (primary) of the diagnosis codes.

On a HCFA claim form, this is Box 21D. You can also checkout the new HCFA form 2014 of CMS-1500 for ICD-10 and ICD 10 Codes for Chiropractors despite the ICD 10 Delay till October 1, 2015.

Chiropractic Billing ICD 9 Codes For Medicare

The only approved primary diagnoses codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:

• ICD 9 739.0 Nonallopathic Lesions of the Head Region not elsewhere classified
• ICD 9 739.1 Nonallopathic Lesions of the Cervical Region not elsewhere classified
• ICD 9 739.2 Nonallopathic Lesions of the Thoracic Region not elsewhere classified
• ICD 9 739.3 Nonallopathic Lesions of the Lumbar Region not elsewhere classified
• ICD 9 739.4 Nonallopathic Lesions of the Sacral Region not elsewhere classified
• ICD 9 739.5 Nonallopathic Lesions of the Pelvic Region not elsewhere classified

Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you name the diagnosis, these codes in the list above are the only primary codes that apply to chiropractic services in the Medicare program.

Billing of E&M Codes for Chiropractic Medicine

The CPT Manipulation codes have a built in pre-service that includes the following: “A brief evaluation of the patient, including a review of symptoms and a focused examination of the problem and related areas”. Therein it is not proper to bill an E&M code when the intent to service is for Chiropractic manipulation only.

If a Doctor of Chiropractic Medicine wishes to provide an E&M visit for the purpose of considering other treatment modalities which Medicare statutorily does not allow for reimbursement to Chiropractors, then an added E&M may be billed to the beneficiary.

If an E&M visit is billed to the patient an ABN is not required as this is a statutorily excluded service for DC’s. Nonetheless it would be prudent to advise the patient that Medicare does NOT require an E&M visit prior to chiropractic manipulation and that the E&M charge is for the purpose of consideration of other therapy. If a patient demands that the E&M visit be billed to Medicare make sure the modifier –GX is appended if an ABN is signed or –GY if no ABN is signed.

The importance of proper coding of a diagnosis cannot be overstressed. Accuracy is essential to reimbursement for services rendered and to protection from both malpractice and civil litigation.

However, the use of these codes alone, does not guarantee reimbursement. The patient's medical record must also document that CMS coverage criteria (medical necessity) has been met.