E/M Coding for Chiropractors Made Simple: Pediatric Patients and Beyond

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If you choose an Evaluation and Management (E/M) code on autopilot, you’re not alone. Many chiropractors assume a patient’s age, or a “simple” complaint, automatically means a lower code. That habit often leads to under-coding, especially for new patients. Example: defaulting to 99202 for a 12-year-old “because kids aren’t complex.” In reality, that mindset leaves money on the table and fails to reflect the work you actually performed.

The fix is simple: base your E/M code on Medical Decision Making (MDM) or Total Time, not assumptions. Since the 2021 update, office/outpatient E/M codes 99202-99215 rely on one of those two factors.

Choose by Medical Decision Making (MDM)

For most visits, MDM is the best fit. It’s not about age; it’s about the complexity of your thinking. MDM evaluates three elements:

Number and complexity of problems addressed

  • Are you managing more than one problem? Is a pre-existing condition influencing today’s complaint?

Amount/complexity of data reviewed and analyzed

  • Did you review prior records, order imaging, or consult another provider?

Risk of complications and/or morbidity of patient management

  • What’s the risk tied to your plan today?

Example: A new pediatric patient with postural strain, a possible scoliosis pattern, and care coordination with the pediatrician may easily meet the requirements for a higher-level code. Age doesn’t decide complexity – your decision making does.

Or Choose by Total Time

You can also code by total provider time on the date of the encounter. This includes more than face-to-face minutes: reviewing records, prepping for the visit, counseling the patient/parent, ordering tests, and documenting your note all count.

Common thresholds for new patient codes:

  • 99202: 15 minutes (met or exceeded)
  • 99203: 30 minutes (met or exceeded)
  • 99204: 45 minutes (met or exceeded)

Example: A visit that includes a detailed parent history, posture counseling, and thorough documentation can easily reach 30 minutes, supporting 99203, even for a 12-year-old.

How to Get It Right—Every Time

  • Document intentionally. Capture the thinking behind your diagnosis and plan.
  • Pick one method: use MDM or Time – whichever accurately reflects the work.
  • Avoid note-bloat. Don’t stuff the note to chase a higher code.
  • Stop under-coding. Don’t let age or assumptions lower your level automatically.

The Bottom Line

Before you submit the claim, ask two quick questions:

  1. How much total time did I spend today?
  2. What was the true complexity of my decision making?

When you document clearly and choose the level based on E/M coding for chiropractors (MDM or Time), your billing stays accurate, compliant, and aligned with the value you deliver—no matter the patient’s age.