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Lina Posted Tue 12th of May, 2015 15:56:41 PM

How to code chiropractic initial visit or re-evaluation? F-up visit along with manipulative treatment?
99203 25 99213 25
98940 98940
Does this look right?
Thank you

SuperCoder Answered Wed 13th of May, 2015 00:52:22 AM

For initial visit, bill 99203-25 and 98940.
For re-evaluation or follow-up visit, bill 99213-25 and 98940.

E/M code with -25 modifier can only be used when your documents supports the significant separately identifiable E/M services.

Lina Posted Wed 13th of May, 2015 16:33:27 PM

Thank you for your reply,
I have a few more concerns:
Do I apply modifier "AT" to a visit as well or only the treatments?
And also box 19 MUST be filled? or only if the x-ray was done or consultation? Cause I'm confused with what should be in box 19?

SuperCoder Answered Thu 14th of May, 2015 00:48:12 AM

Use AT modifier with chiropractic codes only. You can put AT modifier on 98940. For Box 19, Please find below the criteria:

1. For chiropractic services, enter an 8-digit (MM | DD | CCYY) or 6- digit (MM | DD | YY) date of the initiation of the course of treatment and enter an 8-digit (MM | DD | CCYY) or 6-digit (MM | DD | YY)
date of x-ray (if used to demonstrate subluxation) in item 19.

2. Enter a concise description of an “unlisted procedure code” or a “not otherwise classified” (NOC) code within the confines of this box. An attachment may also need to be submitted to help expedite claim processing. If more than one unlisted procedure code is reported on the claim, precede each description in item 19 with the line item number that corresponds to the line that contains the NOC code.

3. If a provider is enrolled in the Competitive Acquisition Program (CAP) for Medicare Part B Drugs and Biologicals, the prescription order number (RX order #) must be reported in item 19 on the CMS-1500 Form.

4. Place additional diagnosis codes 5-8 (if necessary) in Item 19. Enter only the number (with decimal if needed) and separate each diagnosis in Item 19 with a comma. [For example: 719.41, 719.42, 816.00]. The diagnosis codes listed in Item 19 should not be for codes that are required for payment, submit a second claim form with the additional required codes in Item 21.

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