In chiropractic care, knowing how to bill is as important as doing spinal adjustments. The 98940 CPT code is key in billing for treatments of one to two spinal regions. It's vital for getting fair pay for treatments.
Chiropractic billing can be tough, but with the right info, it gets easier. The 98940 CPT code is for treatments of up to two spinal areas. It's part of a set that includes codes for more areas, making billing precise.
Using the 98940 CPT code right helps with accurate billing and shows why spinal adjustments are needed. Claims without the AT (Acute Treatment) modifier might be seen as maintenance therapy and could be denied. This shows how important good documentation and coding are in chiropractic care.
Key Takeaways
- The 98940 CPT code is used for chiropractic spinal adjustments of 1-2 regions
- Proper documentation is crucial for successful claims and reimbursement
- The AT modifier is necessary to indicate acute treatment
- Accurate diagnosis codes must accompany the 98940 CPT code
- Understanding billing requirements helps prevent claim denials
- Effective use of the 98940 code supports practice financial health
Understanding the 98940 CPT Code for Spinal Manipulation
The 98940 CPT code is key for chiropractic billing. It covers spinal manipulation for one to two spinal regions. This code is recognized by insurance providers.
Definition and Scope of Coverage
The 98940 CPT code focuses on manual spine manipulation. It aims to correct spinal subluxations. Subluxations are when the spine is not aligned right.
Treatment Areas and Regions
The 98940 CPT code covers up to two spinal regions. These include:
- Cervical region (including atlanto-occipital joint)
- Thoracic region (including costovertebral and costotransverse joints)
- Lumbar region
- Sacral region
- Pelvic (sacro-iliac joint) region
It's important to document the spinal regions treated. Wrong documentation can cause claim rejections, hurting the practice's income.
Medical Necessity Requirements
Chiropractic medical necessity is crucial for the 98940 CPT code. Services are necessary when treating pain from spinal subluxations. It's important to document these issues well for successful claims.
| Aspect | Impact on Claims |
|---|---|
| Proper Code Usage | Reduces denial rates by 20-30% |
| Clear Documentation | Increases successful claims by up to 40% |
| Regular Guideline Review | Improves claims acceptance by 15-20% |
Knowing and using the 98940 CPT code right is key for good billing and patient care in chiropractic practice.
Documentation Requirements and Best Practices
Keeping good chiropractic records is key for smooth billing with the 98940 CPT code. We'll look at important parts of record-keeping. This ensures you follow rules and get the most from your payments.
Essential Patient Information
Every visit needs detailed records. Note the patient's main problem, their history, and current state. Be specific about the spinal issues you're treating. This info is the base of your 98940 CPT code records.
Treatment Justification Records
Explain why each adjustment is needed. Connect your findings to your treatment choices. Mention the exact spinal areas you're working on and how they affect the patient's symptoms. This shows the medical need for your treatments.
Progress Notes and Care Plans
Write clear and detailed chiropractic progress notes. Track changes in pain, movement, and function. Make care plans with goals, expected results, and how long treatment will last. Update these 98940 CPT code care plans as the patient's needs change.
Compliance Requirements
Follow chiropractic billing rules, especially for Healthcare Providers. Use the AT modifier right for active treatment. Keep records current and train staff on 98940 CPT code rules. Do internal checks to keep your practice compliant and financially safe.
| Documentation Element | Importance | Impact on Billing |
|---|---|---|
| Patient Complaint | High | Justifies treatment necessity |
| Subluxation Level | Critical | Supports 98940 code usage |
| Treatment Plan | Essential | Validates ongoing care |
| Progress Notes | Vital | Demonstrates effectiveness |
Modifier Usage and Insurance Guidelines
Chiropractic billing modifiers are key for correct claims for 98940 CPT code insurance. The AT modifier shows active treatment, which is vital for Insurances claims. Chiropractors must make sure the treatment is needed for health reasons.
If Healthcare Providers might deny a service, patients must sign an Advance Beneficiary Notification. In these cases, use the GA modifier on the claim. This tells Insurance the patient might have to pay themselves.
Using modifiers right can greatly affect how much you get paid back. For instance, the 25 modifier shows a different service on the same day. Without it, claims might get denied. The 59 modifier is also important for services that aren't E/M.
| Modifier | Purpose | Impact |
|---|---|---|
| AT | Active Treatment | Required for Insurance claims |
| GA | ABN signed | Indicates patient aware of potential non-coverage |
| 25 | Separate E/M service | Prevents claim denial for same-day services |
| 59 | Distinct procedure | Necessary for non-E/M services |
Insurance rules can change, but most want clear proof that treatment is needed. For chiropractic care, this means detailed plans and notes on progress. Some insurers only allow up to 24 visits a year without permission first.
Maximizing Reimbursement and Avoiding Claim Denials
Good billing practices are key for chiropractic success. With over 35 million Americans seeing chiropractors each year, knowing the 98940 CPT code well is vital. By billing correctly, you can cut down claim denials to less than 10%, helping your practice's finances.
To get the most from your claims, make sure your documentation is thorough. List both primary and secondary diagnoses for each level billed. This links treatment to diagnosis and expected results. Also, remember that up to 94% of chiropractic records are missing important details like evaluation, treatment plans, or why the treatment is needed. Filling these gaps can make your claims stronger and lower denial risks.
Using modifiers correctly is also important to avoid claim denials for the 98940 CPT code. For Insurance claims, use the AT modifier for active treatment and avoid it for maintenance therapy. Keeping up with insurance policies can increase patient payments by up to 30%. Using Electronic Health Record (EHR) systems can also make billing smoother and reduce errors, making the reimbursement process easier for your practice.
Why Partner with Holistic Billing Services For 98940 CPT Code?
Partnering with Holistic Billing Services for billing the 98940 CPT code ensures that your chiropractic practice can navigate the complexities of billing with accuracy and efficiency. With our expertise in chiropractic billing and in-depth understanding of CPT codes, including the 98940 for spinal adjustments, we help you optimize reimbursement and minimize claim denials.
Our team ensures your practice stays compliant by handling all documentation requirements and using the correct modifiers, such as the AT modifier for active treatment. By partnering with us, you gain access to specialized billing knowledge, streamlined processes, and personalized support, allowing you to focus on providing excellent care while we manage the financial side of your practice.
Unlock Your Practice's Full Potential—Explore Our Expert Billing Solutions Today!
FAQ
What does the 98940 CPT code cover?
The 98940 CPT code is for chiropractic treatments of the spine. It covers adjustments for one to two spinal regions. These adjustments help correct spinal subluxations, which affect alignment and movement.
Which spinal regions are included in the 98940 CPT code?
The 98940 CPT code applies to treatments of the cervical, thoracic, lumbar, sacral, or pelvic areas. It's important to document which areas are treated for accurate billing.
How do I demonstrate medical necessity for services billed under the 98940 CPT code?
To show medical necessity, document the patient's pain and how it affects their daily life. Explain how your treatment plan will help. This shows why chiropractic care is needed.
What essential patient information should I include in my documentation when using the 98940 CPT code?
Your notes should include the patient's history, current condition, and complaints. Also, document each visit in detail. This supports the use of the 98940 code.
How can I create effective progress notes and care plans for 98940 CPT code billing?
Write clear progress notes on patient improvements. Outline treatment goals and expected outcomes in care plans. Update these plans as the patient's needs change.
What modifiers are commonly used with the 98940 CPT code?
The AT modifier is used for active treatments. The GA modifier is for Advance Beneficiary Notifications (ABNs). Knowing when to use these modifiers is key for accurate billing.
How can I maximize reimbursement when billing with the 98940 CPT code?
To get the most reimbursement, submit claims correctly and document thoroughly. Avoid common claim denials and know how to appeal them.
What are the key compliance requirements for billing with the 98940 CPT code?
Keep patient records up to date and follow documentation rules. Use modifiers correctly. Stay informed about regulatory changes and consider audits for compliance.
