Q:
 Dr. M

I want to see if you could help me here...   Perhaps you have 
responded to these Q's before, and I can read that email, 
but here it is: 

Insurance: 

I need to know what codes(the whole gamut) are "descriptive" of the 
diagnosis and work done (and/or with in the scope of) in 
a chiro practice and when its most appropriate to use them, in what 
combination, and for how long, when to change the 
diagnosis, etc. 

Really, in 3 years in my own office receiving "tips" from various 
practitioners, no one ever comes out with the bottom line. 

Something like this: (example) 

These codes mean this ____________.   and you can bill them if 
your patient complains of and appears to have this or 
these____________.  You can bill it for ______ weeks with these 
symptoms or findings.  You can bill the adjustment and 
these other (manual) procedures_________, but you should show 
improvement in the case by gradually billing in this 
manner_________. 

Also...  patients who are coming in for life...  they have new benefits 
every year, should they be billed for the max. allowed visits 
each year and then put on their wellness cash plan.  Should the Dx be 
automatically changed every year, or more frequent to 
continue the allotment of care for "new injuries".  Does the 
repetition of chiro bills to ones insurance every year create a 
history 
of "injuries" which could jeapordize their qualifying for future 
health ins. or disability ins. or life ins., etc. ?

And then, a biggie too, ...if a DC is billing "Dx's" then is he 
"diagnosing (by law?)" and therefore practicing medicine with out a 
license, or at least "treating" what ever he Dx'ed, and therefore have 
significantly greater malpractice liability for the "treatment" 
of the disease or injury  Dx'ed? (or mistreatment and misdiagnosis; 
and is now responsible for the treatment not working and 
delay of necessary medical treatment)?  So, should a DC only bill 
"subluxation codes"(medical term which insights challenges 
from the ins. co.) and _______codes, so that he can substantiate 
that he is  NOT diagnosing and treating anything, only an 
expert in the detection and correction of the VSC.  (Then this 
understanding is spelled out in your paper work so that the 
patient knowingly enters your care for VSC correction, and all other 
maladies are between them and their MD.)
 
Each of those are questions or statements, I have not been able to 
get the frank answer on. 
However you may be able to help I very much appreciate it !

Thanks So Much, for your time and energy !!!

A:

There are many resources for codes .. if you check my webpage: www.chirosmart.net and 
look under weblinks and within there look for publications or practice something .. just 
scrool down for a company called ChiroCode .. they have either a CD or booklet on the 
most recent codes. I use very few codes that seem to always work; If you have  fax 
machine and reply with a number I will fax you my superbill with about 20 codes that work 
well.

Remember that the first number will be the one the insurance carrier keys in first so it 
should be the strongest. I use 729.1 and then the specific area 723.1 for cervicals or 724.2 
for lower back etc. For medicare you must always use a 739 first .1 for cervical, .2 for mid 
back and .3 for lumbars. If you use regular coding with it .. like I will fax you .. it will 
sometimes get you more visits.

Changing the DX is important if you intend to see them for a good while and the insurance 
covers it. This is especially important if the patient has a relapse or new condition. Note 
this and provide a new DX. Remember also that the examination codes change after a 
patient has been seen by you within the previous 3 years or so. Rather than a 99203-25 
(which I use for my standard new patient examination .. a re-exam or a re-established 
patient .. even after an absence of a year or so must be changed to 99213-25 (this lets the 
insurance provider know that they are not a new patient in your office .. the charge is 
generally less .. but not by much

As far as future maintenance and then reactive care .. not use the word injury as the cause 
use illness .. unless there was a legitimate injury. I always give the patient a few months 
without insurance and then reactivate them. You can use the same DX codes .. trying to be 
too creative will get you in trouble .. probably the only trouble is denial for payment. I 
would imagine that constant notation injuries may be a problem with disability insurance .. 
the word illness is milder in tone.

As far as the philosophical  question of whether we DC's should DX or not .. this is 
standard within the healthcare professions .. so don't be concerned about it. Stick to the 
DX we use as chiropractors without mentioning functional conditions such as sinus and 
ulcers etc. and you'll be okay. I may be wrong ..but most insurance providers have no clue 
and probably no place in their computer for a subluxation. This is a chiropractic criteria for 
care not a DX for the insurance providers .. I wouldn't use them. But .. please use it to 
explain to the patient where we differ from the medics and why they need the care.

If this is not clear .. reply for a specific point or two. There are insurance books .. you may 
wish to purchase one from Chirostore. I will send an e-mail to Marilyn Gard from 
Clinicpro a software program and owner of Chirostore .. she wrote a neat insurance book 
years ago. I hope she'll reply to you.