How to Bill Chiropractic Diagnosis 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 how to bill diagnosis codes correctly.

For chiropractic claims, since Medicare only covers spinal manipulation for the correction of a subluxation, we 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.

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

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified

-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified

-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified

-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified

-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified

-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. 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.

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

A big caution here, though. Failing to use these codes in the primary (1st position) diagnosis will virtually guarantee a DENIAL!

So, be sure to use the correct diagnosis codes when billing Medicare for chiropractic claims and you have taken the first step in getting your claim paid!

Tom Necela, DC, CPC is the President of The Strategic Chiropractor, a consulting firm dedicated to helping chiropractors maximize reimbursements and minimize their risk of audits by teaching sound billing, coding, documentation and collections strategies. If you'd like more information about Dr. Necela's consulting programs (which include a Documentation Self-Audit), go to http://www.strategicdc.com

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