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Chiropractic Coding & Compliance Alert

Reader Question:

Know the Codes Your Payers Accept

Question: How do we learn which codes a payer will allow?

Texas Subscriber

Answer: Even though the LCDs are being continually updated, they are still your best bet for knowing what a payer allows. If your code is listed in the LCD, chances are that Medicare and other private payers who are following suit would allow your code for reimbursement. Here are some generalizations that may help your thought process while pinning down those claims:

  1. Most of the codes have one to one crosswalk from ICD-9-CM to ICD-10-CM. Therefore these cross walked codes in ICD-10-CM, whose predecessor ICD-9 codes were allowed by your payers, stand a good chance for payment.
  2. For new codes and combination codes, with no such background of preexisting ICD-9 codes, go by your scope of diagnoses, well supported by appropriate documentation.
  3. For more detailed information on the exact codes eligible for reimbursement, you will have to be on your toes for updates from your payers. Or better still, you could ask them for this information.

The CMS ombudsman, the ACA, and other governing entities are also there to help clarify certain ICD-10 issues that might arise.