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Chiropractic Coding & Compliance Alert

Reader Question:

Use Modifier 25 for Distinct Services

Question: The DC evaluated a new patient and performed chiropractic manipulative treatment in the same visit. Is there any modifier that we should be using to get paid for both the evaluation and the treatment?

North Dakota Subscriber

Answer: Turn to modifier 25 (Significant, separately identifiable evaluation and management service performed by the same Physician or Other Qualified Health Care Professional on the same day as a procedure or other service). This modifier, when used on established or new patient evaluations, implies that the evaluation was above and beyond the usual pre-service work component of the associated manipulative procedure.

Insurers may not pay for exams without the 25 modifier when a manipulation code is also billed for the same date of service. Exams billed without the modifier but with a manipulation on the same date of service may be denied. Please ensure that you report the 25 modifier so that you do not face payment issues and delays.

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