Billing chiropractic claims for a Medicare beneficiary may seem complicated because of the sheer volume) of regulations that are specific to the chiropractic profession. In this article, we will focus on how to document diagnosis codes correctly.
When considering chiropractic claims, since Medicare only reimburses spinal manipulation for the correction of a subluxation, you must include a diagnosis of subluxation in the primary diagnosis position.
On a HCFA claim form, this is Box 21D.
The only permitted primary diagnosis codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:
-- 739.0 Nonallopathic lesions of the head region not elsewhere classified
-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified
-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified
-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified
-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified
-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified
Don't worry if you use different terminology. Some doctors of chiropractic and coding books refer to these diagnosis terms as subluxations or segmental dysfunctions or other such terms.
For example, 739.1 may be listed as cervical subluxation in some coding books. Regardless of what you label the diagnosis in respect to terminology, these codes in the list above are the only primary codes that apply to chiropractic claims for Medicare.
Be careful.The use of these codes does not automatically approve payment however, because your chart notes must document that CMS coverage criteria