From: DH Leavitt, President ChiroCode Institute dhl@chirocode.com This is the biggest reimbursement news of the month, and perhaps of the entire year. The full story will be featured in our March 2002 ChiroCode Hot Topics newsletter. Don't miss it! Now, without question and/or denials, Doctors of Chiropractic MUST be paid for 97112, 97124, and 97140 (neuromuscular reeducation, massage, and other manual therapy techniques) when "performed at separate anatomic sites or at separate patient encounters on the same date of service" as the Chiropractic Manipulative Treatment (CMT) services (98940-98942). Commencing April 1, 2002, Version 8.1 of the National Correct Coding Initiative (NCCI) edits by the Centers for Medicare and Medicaid Services (CMS) will show the newly corrected edits. Although the edits were only designed to administer the federal programs such as Medicare, Medicaid, Mail Handlers, etc., many private insurance payers and state governments have followed them with the FALSE assumption that they were also correct for non-Medicare claims. Consequently, millions of dollars in claims have been improperly denied during the past 2 years. A March 12th, 2002 letter from AdminaStar Federal, the CMS Contracted Carrier and Intermediary who develops and maintains the edits, also justified the continued use of the edits by stating: "CMS is not deleting the edits because providers other than Chiropractors also bill CPT codes 98940-98942." That is a very interesting disclosure. Now we need to ask: "Who else is using CMT services, MDs, DOs or PTs"? According to the letter, on April 1, 2002 these codes will carry the NCCI superscript modifier of "1". This means that these codes can also be used with a modifier, such as -59 (for Distinct Procedural Service). It is important to remember that the 97112, 97124 and 97140 codes are each for 15 minutes. Hopefully, doctors who did these additional services as "distinct procedures" documented the time in the patients1 charts. Those with good records can and should now appeal their previously denied claims. One doctor who documented properly is now asking for about $70,000. Awareness precedes change! An education process is urgently needed by both doctors and payers. This important March 12, 2002 CMS letter will be of great education value when appealing denied claims. Doctors, coders, billers or payers who want a copy of the official letter from CMS can simply visit the ChiroCode Institute web site at <">http://www.chirocode.com> ChiroCode Institute is honored to have played a part in this victory for Doctors of Chiropractic. Success to you in 2002, DH Leavitt, President ChiroCode Institute dhl@chirocode.com <">mailto:dhl@chirocode.com>