Re: Medicare: the beating goes on

[Guest guest]

OK guys, I usually just read and learn from all of you, but figured that maybe I had something to add this time. A few years ago we signed on with a billing service and the owner taught me a lot about Medicare billing and its all in the diagnosis,,, I have much better success getting my Dr his minimal payment on these patients. Before that we to just wrote off most all of the Medicare charges as to not go through all the headaches caused by working hours, getting mad, and tired to try to collect our measly $30 bucks per treatment.

Anyway he sent me a list of diagnosis codes that Medicare will pay on. the first code of course has to be a sublixation but u have to have a secondary that will allow for the amount of treatments that the patient will need so I'm going to take the time to put this in this letter so you can print it,, honestly i get paid about 70 to 80% of the time, unless they have a primary other then Medicare that dose not pay chiropractic then Medicare fallow suite with there primary, I usually find this with Regence BCBS. Please forgive any typo's I will make sure the codes are right

Whew!!!!! ok its all typed in here hope it makes sence

Baertlein

Primary ICD-9 codes

739.0 occipitocervical region 739.1 cervical region

739.2 thoracic reign 739.3 lumbar region

739.4 sacrococcygeal region 739.5 pelvic region

Secondary ICD-9 diagnosis

category 1 diagnosis (diagnosis that generally requires short term treatment}

307.81 tension headaches

721.0 cervical spondylosis without myelopathy

721.2 thoracic spondylosis without myelopathy'

721.3 Lumbosacral spondylosis without myelopathy

721.90 spondylosis of unspecified site without myelopathy

723.1 cervicalgia

724.1 pain in thoracic spine

724.5 backache, unspecified

784.0 headache

Category 2 Diagnosis {usually requires moderate term treatment}

353.0 brachial plexus lesion

353.1 Lumbosacral plexus lesion

353.2 cervical root lesion, NEC

353.3 thoracic root lesion, NEC

353.4 lumboscaral root lesion NEC

353.8 other nerve root lesion NEC

719.48 pain in joint {other specified sites} { must specify spine}

720.1 spinal enthesopathy

722.91 other and unspecified disc disorder cervical region

722.92 other and unspecified disc disorder thoraco

722.93 other and unspecified disc disorder lumbar

723.0 spinal stenosis in cervical region

732.2 cervicocranial syndrome

723.3 cervicobrachial syndrome

732.4 brachial neuritis or radiculitis NOC

723.5 torticollis unspecified

724.01 spinal stenosis thoraco region

724.02 soinal stenisis lumbar region

724.4 thoracic or Lumbosacral neuritis or radiculitis

724.6 disorders of sacrum ankylosis

724.79 disorders of coccyx coccygodynia

724.8 other symptoms referable to back, facet syndrome

729.1 myalagia and myositis unspecified

729.4 fascitis unspecified

738.40 acquired spondylolisthesis

756.12 spondylolisthesis

846.0 spr/str sacroliacic region Lumbosacral { joint ligament}

846.1 spr/str sacroliacic region sacroliac ligament

846.2 spr/str sacroliacic region sacrospinatus { ligament

846.3 spr/str sacroliacic region sacrotuberous ( ligament

846.8 spr/str sacroliacic region other specified sites of sacroiliac region

847.0

847.1

847.2

847.3

847.4

category 3 diagnosis that may require longer term treatment

721.7 traumatic spondylopathy

722.0 displacement of cervical intervertebral disc without myelopathy

722.10 displacement of lumbar intervertebral disc without myelopathy

722.11 displacement of thoraco intervertebral disc without myelopathy

722.4 degeration of thoraco or thoracolumbar interverebral disc

722.51 degeneration of thoracic or thoracolumbar intervertebral disc

722.52 degeneration of lumbar or Lumbosacral intervertebral disc

722.81 post laminectomy syndrome cervical region

722.83 post laminectomy syndrome lumbar region

724.3 sciatica

the policy requires two diagnosis for each sublixation, a primary disgnosis of 739.0-739.5 and a secondary diagnisis from one of the three categories, this diagnosis being the cause of the sublixation, since after January 1, 1997 the chiropractor may bill for manipulations of up to five sperate regions (a sublixation in each reign ), this diagnostic requirement may lead to five different primary diagnosis and five different secondary diagnoses

The HCFA claim for has space in 21 for four diagnoses, electronic submitters also have the option of submitting up to four diagnosis in the national standard format record EAO fields 30-33 Item 24d (hcfa_1500) or NSF record FAO field 14 will accept one of the four diagnosis as a diagnosis that justifies the treatment / service reported. It fallows then that since both paper and electronic claims cannot accept more then diagnosis and if three four and five regions were treated leading to six eight or ten diagnosis the question will be asked as to which four diagnosis to put in the claim form. for cpt-4 code 98940 the claim for can accept the four diagnosis that may be appropriate for 98942 the chiropractor should enter into item 21 {HCFA -1500), NSF record EOA fields 30-33 the two most clinically significant primary diagnosis and there two primary diagnosis and enter one in the item 24e (HCFA)

[Guest guest]

In a message dated 2/24/02 4:43:48 PM Pacific Standard Time, chirodoc@... writes:

MekaAbou@...,

[Guest guest]

Thanks for the information. I've been aware of it for some time and code the

appropriate codes. I'm sure there is someone on this list who'll need the

information. Thanks again,

don white

[Guest guest]

My pleasure