Do you frequently receive denials for your chiropractic services? Your billing procedure might be the issue.
According to a consumer survey, chiropractic care performed better than all other back pain relief options, despite being an unconventional approach. The efficacy of this therapy is causing patients to move away from prescription medication, deep tissue massage, and over-the-counter pharmacological therapies.
However, the increase in demand would make medical billing for these services more challenging. Thus, this is a guided blog on CPT code 98942, which is another common code in chiropractic billing. It will help you understand the billing procedures for this code. So let’s begin!
CPT Code 98942 – Description
CPT code 98942 is a procedural code for billing chiropractic services. During this treatment, the practitioner applies various manipulation techniques to affect joint and neurophysiological function in five spinal regions. The five spinal areas include:
- Cervical (neck and the area that supports the head, C1-C7)
- Thoracic (upper back, T1-T12)
- Lumbar (lower back, L1-L5)
- Sacral (pelvic region, S1-S5)
- Coccygeal or coccyx (tailbone)
Scenarios Where CPT Code 98942 is Applicable
The following scenarios will help you understand the accurate application of CPT code 98942.
Lower Back Pain from an MVC
Persistent lower back pain (LBP) is a somewhat prevalent complaint after a motor vehicle collision (MVC). At least 31% of exposed people reported having LBP one year after the crash. This frequently causes discomfort that radiates throughout the spine.
So let’s take the example of a 35-year-old woman who had an accident in her mid-20s. Now she is having persistent lower back pain, which is affecting her daily life. Her chiropractor examines the spine and discovers that all five regions have subluxations or dysfunctions.
A full-spine chiropractic manipulation is used to ease muscle tension, increase spinal stability, and promote healing. To correct trauma-related imbalances, specific adjustments are needed in each area. Therefore, CPT code 98942 must be reported because the chiropractor treats all spinal regions in a single appointment.
Chronic Back Pain
Consider a 30-year-old man with neck stiffness and lower back pain that affects his ability to perform daily office duties. He goes to the closest chiropractor, who determines his pain sites and develops a treatment plan. Manual manipulation is applied to all five spinal regions as part of the treatment to improve joint mobility and nervous system function, and reduce pain. Hence, he can use CPT code 98942 to bill for his services.
Postural Imbalance
Patients with poor posture or spinal misalignment that impairs balance and body symmetry usually require a full-spine adjustment.
Consider a 32-year-old woman who telecommutes and often works on his bed for extended periods, resulting in poor posture. This has resulted in neck stiffness and back pain. A chiropractic examination finds subluxations in all five spinal areas, leading to unequal shoulders, tilted hips, and persistent lower back pain.
Now, to restore her postural balance, the chiropractor uses manual manipulation to address pelvic rotation and spinal curvature. CPT code 98942 is the appropriate code to record such comprehensive treatment since the entire spinal column was adjusted, from the cervical to the pelvic region.
Applicable Modifiers for CPT Code 98942
You may apply the following modifiers to CPT code 98942.
Modifier 59
Modifier 59 is utilized for services that are separate from the primary service. For instance, if you provide both massage therapy (CPT code 97124) and manual manipulation of a spinal area on the same service date, you can attach this modifier to CPT code 98942 to inform the insurance payer that the two services are distinct and separately reimbursable.
Modifier AT
Chiropractic practitioners must include the modifier AT with their claims if active chiropractic services were offered. Failing to do so will lead to claim rejection.
This modifier represents that the services provided to the patient were part of corrective treatment aimed at enhancing the patient’s health rather than maintenance care.
CPT Code 98942 – Billing & Reimbursement Guidelines
The following reimbursement and billing guidelines will help you dodge denials on CPT code 98942.
Ensure Detailed Documentation
Thorough documentation with complete and comprehensive information is a key to accurate reimbursement. On the other hand, inadequate documentation and incomplete proof of the medical necessity are among the top reasons for billing denials. Therefore, the initial step is to ensure that your documentation for chiropractic manipulative treatment of the five spinal regions is both accurate and comprehensive.
Furthermore, ensure your session notes contain sufficient details to support the application of this code. The following information must also be included in the documentation:
- Patient history and reason for treatment
- Review of imaging or prior examinations
- Physical examination findings
- Treatment plan and goals
- Progress tracking and patient response
Append Modifiers When Needed
Applying correct modifiers (when necessary) is essential for billing. As we have discussed in our modifiers section, modifier AT is exclusively used with chiropractic techniques. If CPT code 98942 is submitted without the AT modifier, Medicare will deny the claim since maintenance therapies are not eligible for coverage.
Verify Payer Policies
We recommend that all billers set this basic rule to read the policies of different payers before submitting claims to them. Why? You must understand how various payers process claims, assign reimbursement rates, and set the rules for the acceptance of codes/modifiers.
Let’s take an instance of Medicare here! It does not accept claims of CPT code 98942 unless an AT modifier is included. It is set in their rule book that if the modifier is not appended to the claim, the payer will presume that the services provided were only for routine maintenance.
Hence, this proves how essential it is to remain informed about payer requirements, changes in coverage criteria, and new regulations regarding chiropractic billing.
Conclusion
Let’s review what we discussed before we conclude this blog. First, we talked about how the CPT code 98942 represents chiropractic manipulative treatment involving all five spinal areas in a single session. Then, we backed up the description with a few real-world examples that clarify how the code is used in clinical situations. We also emphasized the significance of the modifier AT.
Finally, we covered all of the crucial billing rules that you need to adhere to in order to submit precise and flawless claims.
However, we highly recommend that you consider professional chiropractic billing services if this information hasn’t resolved your confusion.
