Medicare Archives

Medicare Diagnosis Rules

As with all treatments and services in chiropractic, Medicare has its own set of rules, policies, and procedures. It is particularly important to be clear about the diagnosis rules regarding Medicare patients. You should review Medicare’s guidance in your Local Coverage Articles, and revisit them frequently to stay on-top of any changes. Doing so will…

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Idiosyncrasies of 97010-Hot/Cold Packs

ACA & CPT Code 97010 Code 97010 is often misused and overbilled. The most common reason is that it is difficult to establish and prove medical necessity for this service, and very often, the documentation does not include appropriate rationale for using this code. Below you will find what the American Chiropractic Association (ACA) has…

Billing Electric Muscle Stimulation to Medicare

Electrical Muscle Stimulation (EMS) Being Accepted by Medicare A common question in billing physical medicine codes to Medicare involves electrical muscle stimulation. Since Medicare is required to follow, and helps define CPT coding guidelines, why is the CPT code 97014 denied when billed to Medicare? And why is the CPT code 97014 often denied as…

Excluded Service Modifiers Can Make or Break Your Claims

Now that you’ve learned about the difference between modifiers for spinal CMT codes, and those for excluded services, let’s dig a bit more into two critical excluded service modifiers. The GP and GY modifiers may seem unimportant because they are appended to codes that are not covered by Medicare. But misuse or omission of either…

Examine Medicare Modifier Usage

This colorful, visual reference discusses modifiers and some of the acronyms used and misused in coding. It is offered as a down-to-earth dialogue that is easy to read and makes the information easy to retain. Study it and share it with your team members to provide a better overview of Medicare modifiers in your practice.

Maintenance Care Coding

Coding for maintenance care is different from coding for active care. And there are as many opinions on how it should be done as there are ways to do it. It’s critical to remember that for Medicare maintenance, the rules are different from coding for non-Medicare maintenance care. This short training explores the differences and…