Archive for December, 2009

Chiropractic Billing Ignorance or Fraud? Inconceivable!

by Tom Necela on December 29th, 2009 in Audits, Billing, Business, Coding, Documentation, Politics, compliance

Reading time: 5 – 8 minutes

inconceivable

“You keep using that word,” Inigo Montoya says to Vizzini in the cult-classic comedy The Princess Bride. “I do not think it means what you think it means.” The word that Vizzini so frequently misuses in the film is inconceivable. Unfortunately, it’s a term that seems to be floating around in the heads of too many chiropractors as well.   As we near 2010, many chiropractors are now painfully aware that their coding and billing activities are being scrutinized more closely than ever before.

(Inconceivable? Read on…)

If you have been following recent legislative developments, you will have noted increasing overpayment recovery efforts by Medicare and its contractors. The current administration has declared that health care fraud enforcement will be a top white-collar crime priority for the Department of Justice (DOJ) and the various investigative agencies. Moreover, additional funding to fight health care fraud has recently been proposed in the Senate. Senator Ted Kaufman (D-DE) has sponsored the Health Care Fraud Enforcement Act of 2009, which, in addition to increasing the criminal penalties for health care fraud, allocates an additional $20 Million per year for health care fraud detection and investigation.

($20 Million extra for fraud detection?  Inconceivable!)

While universal health care coverage may remain controversial, there is widespread support for additional legislation aimed at reducing health care fraud. This is not an attack on chiropractic per se (that would be inconceivable!) — these guys are going after every health profession at large!

Though I hesitate to get involved in all manners of political wrangling, there are some major issues creeping our way which can vastly affect our profession of chiropractic.  We need to be aware of these not only on a profession-wide political level, but also in terms of how they affect our everyday practice.

If you haven’t already heard, here’s what’s coming unless someone puts a stop to it:

  • Requiring that the U.S. Sentencing Commission amend the Federal Sentencing Guidelines to redefine the term “health care fraud offense” to include all health care crimes, regardless of where they are codified. Notably, it would also increase the offense score associated with health care fraud offenses, considerably increasing the length of any sentence handed down by the Court;
  • Making it clear that all payments made in connection with illegal kickbacks constitute “false claims” under the False Claims Act; and
  • Clarifying that it is not necessary that a defendant be aware that their conduct violates a specific provision of criminal law in order for them to be held accountable for their actions. Instead, a person would be guilty of a health care fraud offence if he (or she) knowingly does what the law forbids.  (Inconceivable!)

That last proposed provision in Senator Kaufman’s bill should scare the bejeebees out of all small physician practices, including (and perhaps) especially chiropractors. Here’s why:

Unlike the big entity hospitals who have a fleet of attorneys to defend their every move, this provision puts the small timer at a big mechanical disadvantage.

To make matters worse, we have another problem related to the meaning of the word fraud.  For many physicians, Inigo Montoya’s clarification is again applicable:  “I do not think that it [ in this case, the word fraud] means what you think it means.”

For many of us, we have heard lawyers argue that the fine line between what constitutes fraud and good old fashioned red blooded ignorance (oops I made a mistake) is intent.

This definition makes sense to me, as a non-lawyer type.  If I repeatedly conduct my business or an aspect of it (say documentation, billing or coding) in a way that is deemed illegal, substandard or just plain wrong and despite my knowing better, I continue to do so for financial gain, this seems like a reasonable definition of fraud.  On the other hand, if I don’t really know what I am doing, I may be wrong but it is out of ignorance not bad intentions.  Consequently, the ignorant (but well meaning) doctor who is reprimanded, fined or otherwise correct then proves that his intent was always good by doing one thing:  he corrects his actions.

Again, I am not an attorney, but if this provision passes through, I believe it sounds like the word fraud may not mean what we think it means.  Or at the least, the lines of intent will be sufficiently blurred to be inconsequential. It won’t matter whether you acted honestly but erroneously; you will still be guilty of health care fraud.

The Bottom line: I see a few action steps here:

1. Now, more than ever, is the time to support your local (state) AND national association to help fight these battles on our behalf!  No excuses.  Most state or national memberships will cost you the equivalent of one adjustment per month to join.  Membership in both will run you two whole adjustments per month.  The safety of your livelihood is certainly worth that much regardless of your political persuasions, philosophical differences or nitpicking with their ability to fulfill your agenda.  Get over it and support these associations now!

2. Training in compliant billing, coding, documentation should be a priority for both doctor and staff. The only way you can adequately defend yourself, prevent fraud and screen for errors is to know what you are looking for.  Unfortunately, chiropractors are either woefully inadequate at detecting their own problems or unwilling to address the issues.  Both can have devastating effects on your practice and the profession.

3. Encourage each other to rise to a higher level. Many states are requiring billing, coding or documentation education as a part of their CE requirements. State Boards need to be proactive in teaching doctors on how to comply with the requirements of their state before the docs get in trouble. Unfortunately, I have seen many docs disciplined for things that are “grey areas” such as exam documentation, SOAP note requirements, cash or TOS discounts, etc.  If we fail to meet local standards, it’s practically a sure bet that we will fail nationally as well. So we need to go to our state Boards and associations with our challenges and work to find solutions so they don’t become national problems on public display.

Certainly, I am not proclaiming that better billing, coding and documentation will solve all our chiropractic problems (that would be inconceivable!) but a lack of proper systems in these areas will definitely put us at risk for failure in a variety of different forms.

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Changing with the Times in Chiropractic

by Tom Necela on December 22nd, 2009 in Billing, Business, Coding, Collections, chiropractic practice management

Reading time: 7 – 12 minutes

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Although some pundits have declared that the worst of the recession is over, I know that some offices are seeing the pinch of the slow economy and/or the holiday season on their patient’s finances.  And while it may be true that you cannot get “blood from a stone,” don’t take comfort in all the talk of economic doom and gloom by leading yourself to believe that everyone’s practice is down right now.  Those lies are told by those who want others to join them in their own shortcomings.  Plus, it most certainly is not true.

However, this is not to say that chiropractic offices that are thriving in this marketplace by doing the same old thing. For example, my client who called to tell me he was still alive (hadn’t heard from him in a while, so I sent him a search & rescue email!) has been busy adapting new strategies for his office, adding staff and been busy, busy, busy to the tune of a $60,000+ increase in the last three months since he hired me.  His excellent stats are not the result of pure luck, being in the right place at the right time or multiple mantras chanted towards attracting infinite abundance.  Sorry to all you fans of “The Secret” or other similar think and grow rich spinoffs – this fella did the work, made some proactive changes and is reaping the rewards of his smarter strategies.

Let me make one thing clear: I am not telling you to start to do your own billing, over the counter collections or put a register in your treatment rooms to collect co-pays!  However, I do think that, as the CEO of your business, you need to spend time in consideration of the way your office currently handles finances.

Unless you have been wearing blinders for several years now, $5 co-pays and $250 deductibles are becoming as rare as a monogamous celebrity.  In many cases, the insurance step children have taken their place in the form of $50 co-pays and $5000 deductibles.  Obviously, the clinic who approaches patient finances like it were 1985, 1995 or even 2005 has strategies that either won’t quite fit in today’s environment or ones that don’t even border on reality.

Instead, savvy practices that are succeeding today are coming up with an assortment of ways to make sure that the patients still get the care they need AND to ensure they are paid to deliver it.  Here are a few ideas and tips to think about in this regard:

1. Your Credit Card machine is mandatory. The first line of defense for a patient who doesn’t have cash on hand – be it for a co-pay, deductible or to purchase the bulk of needed care –  is to have a credit card machine.  You are a dinosaur if you don’t.  Those of you who would laugh at the notion at someone practicing without a credit card machine need to meet some of the characters who send me snail mail because they “don’t do internet.”  I bet they “don’t do credit card machines.”  And it is likely, they “won’t do practice” for long either.  Get the machine.  And for those of you who have one, shop yearly for transaction rates, fees and other little ways the companies will suck more of your money than need be.

2. Consider Auto-Debit. Some people don’t like the idea of paying 22.5% interest on their credit card which seems to be the direction many companies are headed.  As an alternative, allow them to make payments.  But whatever you do, refuse to accept payments the old-fashioned way!  In other words, someone owes you $500 and your well-meaning staff member agrees to accept $50/month payments only to find out that 10 months turned into 17, included 19 reminders sent by your staff to get the $500 and in total, you actually lost money by spending more in staff time than you received.  Instead, use auto-debit through your bank or a processing company such as FirstACH.com or PaySimple.com.  Patients are used to having their bills paid this way, and with a simple form, they can pay you the money over time without having it be a headache and a financial nightmare on the back end.

3. Make Sure Your Hardship Agreements are in Writing. Some of you are too easy on what constitutes a hardship in your clinic and you waive co-pays at the drop of the hat.  Not only is this potentially dangerous for legal and/or contractual reasons, it may make little business sense.  Certainly, if someone is in need, you want to get them the care because you have a good heart.  But be sensible about this.  DEFINE what a hardship is and stick to it.  I get way too many emails from staff that complain about their doctors being all over the map in this regard.  Get the poverty levels for your area and see what your state says about who doesn’t have any money and who should qualify for your generosity.  That way, when someone approaches you with what seems like a legitimate financial challenge, you have some concrete criteria to see if they meet the definition legitimately.  One final note: your hardship agreements should be in writing and be temporary (put an end date in which the hardship ends or must be re-qualified).

4. Beef Up Insurance Savvy, Cash Friendly Services. Even though much of the coding, billing and documentation advice I give slightly favors third party payment systems, it is a wise move to have services that are both reimbursable through insurance and for which patients readily pay cash.  My favorite choice in this category is massage therapy because it costs little to start up, has excellent profit margins, generates quick cash flow, is frequently reimbursed by insurance companies and routinely paid for in cash as well.  My How to Build a $300,000 Massage Practice in Your Chiropractic Clinic program is one of our top sellers for this reason – and it continues to get rave reviews because the program is a simple step-by-step model for how to create a successful massage department.  Certainly, massage is not alone in the insurance savvy, cash friendly category; but I do believe it outweighs the other choices by a large margin.

5. Clean Up Your Messes. Many of us are willing to point the finger at the patients or the economy for our financial struggles when the real answer is the mess that is in our own backyard. To put it bluntly, you will never achieve high levels of financial success if your Accounts Receivables are too high or inappropriately pushing beyond the 90 day mark.  If your billing person (or system or company) is a mess and can’t get you paid, there is no amount of compensating you can do on the other side to squeeze more profits out of your patients that will ever balance the scale.  Finally, if your documentation and your coding systems stink or were passed down to you by Uncle Louie, DC who was a big roller in the 70’s,   you are in for financial trouble at the least.  In today’s marketplace of heavily scrutinized claims, post payment demands and recovery audits, it makes little sense to bill for anything and everything with little attention paid to proper billing, coding or documentation standards because you will only to pay it back later.  Instead, spend some time cleaning up your own messes.   If you have even an average practice in terms of volume and visits, I can virtually guarantee you are leaving hard-earned money on the table because of your lack of expertise in these areas.  I say this, not to brag, but because this is what I do every day of my consulting business and there is literally that much to improve in most of our practices.

So, which of these steps are you missing in your practice?

Is it all of them?  Can you survive doing business the same way you are doing it now or is it high time to “kick it up a notch” and change with the times.  You may not be able to do much individually about the state of the economy, but you can do a whole lot about how your private practice handles finances.  So, get to work.  And if you don’t know where to start, consider completing my Practice Analysis Questionnaire so I can give you some guidance in this regard.  There’s no charge nor any obligation to utilize my services, but I am willing to give you some candid opinions/recommendations (like ‘em or not!) for those who take the time to fill out the questionnaire.

Happy Holidays!

Tom Necela, DC, CPC, CPMA

P.S.  For those of you who would like more in-depth strategies, check out my Chiropractic Collections & Financing Secrets program which has dozens of different tips and techniques to improve collections.

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Your Toughest Chiropractic Billing, Coding, Documentation Questions Answered – FREE!

by Tom Necela on December 15th, 2009 in Audits, Billing, Business, Chiropractic Seminars, Coding, Collections, Documentation, EHR / EMR, HIPAA, Medicare, Medicare ABN, OIG Report, chiropractic EMR, chiropractic documentation, chiropractic practice management, chiropractic webinars, compliance, seminars

Reading time: 3 – 4 minutes

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You are invited as a guest to Join Tom Necela, DC, CPC, CPMA — Certified Professional Coder, Certified Professional Medical Auditor, former Insurance Claims Analyst, and current President of The Strategic Chiropractor — for a special FREE 60 minute Webinar!

FREE WEBINAR!


Thursday December 17, 2009

– 9 am PST/10 am MST/11 am CST/Noon EST

So…

Bring your TOUGHEST questions on Chiropractic:

  • Billing
  • Coding
  • Documentation
  • Collections
  • Getting Paid for the Work You Do!

And receive the ANSWERS you need that will help you:

  • Maximize your reimbursements
  • Decrease denials
  • Shorten Payment delays
  • Lower Accounts Receivable
  • Reduce your risk of audits

We are hosting this seminar as a special “thank you” to all of our blog readers, clients and customers who have made The Strategic Chiropractor the #1 source for teaching chiropractors how to “Work SMARTER, not harder” for increased profits.

As a sign of our appreciation we’d like to offer you a FREE seat for this webinar and the chance to have your question answered “live” during the event.

(If you cannot attend or would like a CD copy of the webinar, see below for details.)

Historically, this is our most popular event webinar of the year, so you need to act quickly! Previous editions of this webinar resulted in hundreds more questions than we could physically answer in a limited time format.

Space is limited and ADVANCED REGISTRATION is MANDATORY to submit questions (the earlier you submit them, the better chance they have for being included in the presentation material).  So register below, submit your questions and get your front row seat for the ultimate biggest bargain on the subject of chiropractic, billing, coding and documentation!


CLICK HERE TO REGISTER!


Hope to see you there!

Tom Necela, DC, CPC, CPMA
The Strategic Chiropractor

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The BEST Chiropractic Practice Management & Business Strategies for 2010

by Tom Necela on December 8th, 2009 in Business, chiropractic practice management

Reading time: 9 – 15 minutes

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I am going to divert a little from my usual fare of how to improve your chiropractic billing, coding, documentation and collections and focus simply on how to improve your business.  Specifically, I would like to share with you some of the BEST ways I have observed in building, growing or tweaking your business for maximum results and profitability.

What gives me the audacity to think that I know it all – or even that I possess the keys to such a secret kingdom?  Could it all be a case of poetic license?  For those of you who were fortunate enough to have not majored in literature in college, keep reading so I may explain (with immediate apologies to my former English lit and writing professors who need a jug of Maalox to get through this awful sentence structure).

The First Rule of Branding

The first reason I can claim to write about this topic is that I am writing about this topic. And since these are my fingers dancing across the keys and not yours, I am afforded some sort of grand position of being able to say what I want.  While that sounds rather snotty, snooty and not very much like a good reason for authority, there is a kernel of truth amidst all this candy corn:  the “rules” of marketing permit one to create an image for the public based (in some cases) more on how you wish to position the product or service you are selling, than actual fact or truth.

You will find interesting examples of various “kings” or “queens” or “goddess” of pop, rock or some cultural phenomenon that have simply branded themselves with these titles.  Slogans mentioning such things as “good hands” or “trying harder” or “America’s #1 ___” were not necessarily latched on to their respective owners because they were an accurate descriptor or even the result of some national poll.  They were the brilliant genius of some marketing team deep in the bowels of their corporate hideouts.

Chiropractic is no different. Witness the host of chiropractic gurus who lay claim to the titles “marketing maven,”  “new patient generator,” or other such puffery. You will soon find that these monikers were not thrust upon them by legions of adoring fans, but were more likely tagged after a few pints of Guinness with their buddies that thought it sounded like a good idea.

To come to my first long-winded point, you get to create the perception of who you are to your community.  And lesson #1 is the chiropractic MBA program should be that you need to create a perception of who you are to your community in order to distinguish yourself from your fellow chiropractic brethren, from MD’s, PT’s and anyone else that could potentially steer your clients elsewhere.  My point is not to create some hypercompetitiveness among chiropractors.  In fact, our techniques and methodology vary so much, the strategic chiropractor has little reason to worry about his neighboring chiropractor(s) at all.

Don’t Simply Follow the Herd

This brings me to my second point regarding chiropractic business success.  You must position your clinic strategically and approach the marketplace from a clear position of strength.  There is a reason that my business name is The Strategic Chiropractor.  It revolves around the fact that I aim to teach chiropractors how to better their practice in a deliberate, methodical, planned out – strategic – ways rather than the haphazard or one-size-fits-all slop that pervades our profession.

And so it saddens me when I hear chiropractors moaning that there are too many DC’s in their town.  All this tells me is that they have failed to distinguish their business from other chiropractic businesses in any meaningful manner.  In reality, they probably never thought about what makes them different than any other form of health care either.  Like it or not folks, the days are loooong over when you can throw up your shingle, open your doors and expect patients to waltz in.

Similarly, just doing what every other chiropractor is doing with the latest marketing gimmick or purchasing the hottest new piece of equipment will not necessarily equate to success for you either.  This is why so many of you have expressed frustration with chiropractic coaching programs which serve you little in the way of tangible practical value but offer a platform for some crusty chiropractor to tell you how great he was (note was, not is – many haven’t practiced for 10+ years) and in order to build your practice, you must mimic his greatness.  Furthermore, how can the same ad possibly work in every city and town across the country or the globe without diminishing its uniqueness or effectiveness? Not to mention that it may not even remotely match your personal style.

Strategic Planning IS Required

The opposite of all this is to formulate a strategic approach to how you will run your business.  Unfortunately, this is not as glamorous as doing an infomercial, but it doesn’t automatically eliminate that idea either.  It may not require you to run an ad that will simply “kill” but if the return on your investment pans out well, proper strategy may absolutely incline you to run such an ad.

You see, thinking strategically about your business requires time and effort and planning rather than slapping something together and seeing how it works, regardless of the message it may convey.  The strategic chiropractor realizes that he must consider the consequences of running a cheap or free special, slightly shady advertising or shoddy billing practices and weighing them with the “penalties” of success or failure.

I say “penalties” of success because the wrong ad can bring in the wrong patient.  Chiropractors who simply to try increase their numbers without consideration for the type of patients they are bringing into the clinic run the risk of having a busy practice that can’t possibly be a profitable one.  Perhaps worst of all is a doc who has built a successful practice that was not really a good fit for their personal style or goals.  In other words, they have trapped themselves and now are miserably comfortable in a financial fortress of their own making. So, yes, there can be penalties associated with the “wrong” methods to achieve success.

The Penalties of Failure

Certainly, there are also “penalties” to consider for failure but they are not always what you think.  Most docs imagine a practice that never gets off the ground or dives into the toilet as failure.  While this may be accurate, the failure may be due to a lack of planning.  Serving the wrong market.  Thinking that the location makes patients show up.  Failure to differentiate.

While these will produce failure, there is a darker underbelly that we need to avoid as well.  It is failure to adhere to laws, rules and regulations.  The clinic that has fraudulently billed, the doctor who uses false advertising or the chiropractor who doesn’t bother to document his services properly are also failures in a sense.  But these docs not only fail themselves, they leave their stain on the rest of the profession as well and make it worse for the rest of the good, honest, ethical and law-abiding doctors to practice in their tainted communities.

Every day, I get news items on chiropractors who are being fined, jailed, disciplined, or put on probation for various infractions that all revolve around the fact that the chiropractor failed to engage true strategic thinking about their business.  It could happen no other way.

After all, is it a sound business strategy to double bill the state work comp program for $11,000 in excess services when the penalty is 5 years in jail and/or a $20,000 fine?  Is appearing before your state board to defend your ad that claimed that a certain treatment has a 94% effectiveness an effective and strategic use of your time?  Are you paid well enough that you want to write reports to justify all your treatments because your documentation was so shoddy?  Is it a good business strategy to “build it and they will come” when you don’t really know what “it” is that you are building nor can you define who the “they” is that will come?

The Best Chiropractic Strategies for 2010

While I may be able to employ poetic license to get you to read an article that promises the best business ideas for 2010 and then delivers something slightly different, your patients and community may not tolerate such a slight of hand trick.  But that is exactly what many of us are doing when we utilize poor advertising methods, non-existent business planning, substandard documentation, slippery billing practices and other short-sighted methods that are aimed at producing patients and income.

When it comes down to it, the best chiropractic business and practice management strategies for 2010 are quite simple to understand, but challenging to navigate.  In my opinion, they would include the following:

  • The best business strategy for 2010 is one that will take you beyond 2010.  Never do anything that goes against your long term goals to achieve short term gain.
  • The best practice management strategy is one that reflects who you are and what you are trying to achieve. First, that pre-supposes you have a strategy in place and aren’t just practicing in practice.  Second, it necessitates that your strategy fits you well and isn’t one that some coach slapped upon you.  DC’s who memorize scripts or engage in marketing activities that don’t match their personality are doomed to failure or uncomfortable success.  One of the reasons you own your own business is to exercise creative control, not to don someone else’s leisure suit from the 70’s to see if it works for you. Finally, this best practice management strategy also implies that you know who the strategy is for.  You cannot serve everyone and you don’t have the budget to advertise to the world either.  Instead, you must define your niche of the chiropractic market and serve it well. 

I have yet to see a business fail that has employed the above two ingredients.  Now that you have the recipe, add some of your own seasoning to these ingredients and create your own chiropractic success!  

If you are a little uncertain of how exactly to mix these ingredients together, perhaps it’s time you get some experienced assistance.  While I don’t claim to be an expert chef, I have seen enough in the way of chiropractic success to be able to spot a recipe for success or disaster.  Quite frankly, some of you are leaving so much money on the table due to your billing and coding procedures that profits are just around the corner – if you only knew which corner to turn.  Others are playing with a house of cards due to their substandard documentation and risk their entire business and livelihood with each claim you submit.  And then, there are some of you working much too hard in a business model that is not sound or doesn’t fit — honestly, you just need to work smarter!

Should an objective opinion about your practice be something that you are open to, fill out my Practice Analysis Questionnaire, send it in and I will be glad to provide you with a no charge, no obligation review of your practice and how you may be able to improve your results.

Until then, keep cooking!

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Are You Coding Your Chiropractic Adjustments Incorrectly? New Coding Clarification!

by Tom Necela on December 1st, 2009 in Audits, Billing, Business, Coding, Documentation, chiropractic documentation

Reading time: 6 – 9 minutes

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The October 2009 edition of the CPT Assistant featured some clarification on chiropractic coding issues specific to coding for Chiropractic Manipulative Treatment, both Spinal (98940-98942) and Extraspinal (98943).  In addition to spelling out what constitutes each of the five spinal regions, the CPT Assistant provided some additional clarification on the Extraspinal Regions that was previously left unclear in previous editions of the CPT code book.  Specifically, I would call your attention to the definitions of Lower Extremities and Upper Extremities, which are now well defined.

To give you a little background, the CPT (Current Procedural Terminology) coding book is published each year by the American Medical Association and is the “official” coding standard rules and guidelines for proper coding procedures throughout all health professions.  As the full volume of the publication is quite large, various spin-offs of the CPT book exist (such as ChiroCode) in specialty professions to help practitioners in specific disciplines access the portion(s) of the CPT that are relevant to their profession.  Similarly, the CPT Assistant is published each year for coding professionals (from all disciplines) and it clarifies updates, problems, commonly misunderstood items, deletions and additions to the  CPT codes.

For most issues of this pricey publication, the CPT Assistant has little relevance to anything we do as chiropractors mainly because we represent only a tiny fraction of health professions at large.  To be honest, each year, I wrestle with the idea of canceling my subscription but the occasional nugget of useful information I can pass on to you and/or my clients keeps me going.  The most recent issue of the CPT Assistant has by far the most relevant hairsplitting that has been published on chiropractic in a looooong time.  The issue featured definitions of chiropractic manipulative therapy codes (most of which you already know) but there were a few tidbits that were included that could potentially have a major impact on your ability to bill, code and document your services correctly.  Done right, they can help you INCREASE income.  If done incorrectly, you could be LOSING money.  Here they are:

Extremity Coding Clarifications
For Lower Extremities, perhaps the most critical definition for chiropractors is the inclusion of the “Hip” in this category.  As you know, a patient presenting with a hip problem could really have a chief complaint of SI joint pain, pelvic pain or problems in many other anatomical structures located in the surrounding regions of the lumbar spine, hip, pelvis or sacrum.

Similarly, many chiropractors have expressed confusion over what structures constitute the Upper Extremities.  The present edition of CPT Assistant also clarifies this issue: the upper extremities include the shoulder, arm, elbow, wrist, and hand.  Therefore adjustments that you perform in the Thoracic region of the spine would not include the shoulder, even though some of the surrounding structures are adjacent anatomically.  The CPT Assistant makes it clear: Shoulder Manipulations are Extra-spinal (98943).

From a coding, documentation or billing perspective, it is essential to be specific in your reporting of pain in these areas, as it may have significant impact on your selection of the appropriate CPT code to bill for your services and in turn, the revenues generated from that service.  For example, since the SI joint is classified under Pelvis for coding purposes, adjustments to this region would count towards the number of spinal areas for which you are billing.  On the other hand, if you perform an adjustment to the hip, your service should be coded as an Extraspinal Adjustment (98943) and would not count towards the number of regions you would choose for spinal area adjustments (98940-98942).

Potential Risks and Benefits of This Coding Clarification Obviously, if you incorrectly document, bill or code for any of these regions incorrectly, you run the risk of either upcoding your services (because you have billed for more regions than you truly adjusted) or downcoding your services (because you failed to bill for all the areas you adjusted).  Neither is correct and both have financial implications.

One final note: the CPT definitions of anatomical regions are not consistent with the diagnosis code selections included in the ICD-9 code set.  This discrepancy was pointed out in the 2009 edition of the ChiroCode Deskbook, but its application becomes particularly relevant when dealing with coding issues in reference to the regions mentioned above.  Because it may not be possible to correlate all anatomical regions with specific ICD-9 codes, use extra caution to make sure that your documentation fully supports both your choice of CPT codes and ICD-9 codes.  Failure to do so may result in your claim being denied or delayed.

Now that you have been informed,  the next step is to go back and correct your procedures if you have been doing it wrong.  For those of you who suddenly found out that you are leaving lots of money on the table by the current way you are billing, coding or documenting your services, let me suggest a three step plan:

  1. Fix It! The insight is not the solution — your improvement requires action! So get to it before you expose yourself to potential audit trouble and/or keep losing hard earned money.
  2. Admit That You Don’t Know Everything. This is sort of a “healthy” view of ignorance.  Some call it the beginning of wisdom.  It is the realization that you cannot possibly know everything there is about all aspect of your business.  Certainly there are other similar items that you don’t know that are also costing you money (or will cost you money if you are audited).  Once you can own up to that, perhaps it’s time to fill out my Practice Analysis Questionnaire and see how I may be able to assist you.  My review of your Questionnaire is free and there is no obligation to utilize my services, so the only thing you have to lose is your stubbornness to admitting you know everything.  By the way, just in case you think I may be a little hypocritical here, I don’t claim to know everything either.  It’s highly likely I know more than you about billing, coding, documentation as this is what I specialize in, but you won’t find me telling you how to adjust your patients or what to do with your 401K plan.  For some things, it is helpful to have access to someone with specialized knowledge around. If you can accept that line of thinking, fill out my Practice Analysis Questionnaire and we’ll talk.
  3. Give Something Back.  There is potential for some of you to make big bucks off this blog post due to the fact that you have been doing it wrong for who knows how long.  Take an average of only 20 adjustments per week @ $50 per adjustment for 50 weeks of the year.  That’s a $50,000 impact on your practice for one item!  At the very least, you may owe me a nice dinner (just kidding), should hire me (kidding – sort of — it will cost you less than $50K and make you more) or give something back to the profession (not kidding at all — choose your state and/or national association and send a check – they need the money!).
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