10 Most Common Chiropractic Billing Modifiers

1. 10 Most Common Chiropractic Billing Modifiers

2. 10 Most Common Chiropractic Billing Modifiers • Chiropractic Billing Modifiers • Chiropractic care is a growing industry that is becoming increasingly popular among patients seeking non-invasive treatments for musculoskeletal conditions. However, billing for chiropractic services can be complex and challenging, as it requires a thorough understanding of the codes and modifiers used in medical billing. Chiropractic billing modifiers are codes used to provide additional information about the services provided, and ensure proper billing and reimbursement. In this article, we will discuss ten common chiropractic billing modifiers, including their descriptions, billing examples, and billing tips to help chiropractors accurately and appropriately use these modifiers to optimize reimbursement for their services. • 10 Most Common Chiropractic Billing Modifiers • 1. Modifier 59 • Description: The 59 modifier is used to indicate that a service was distinct or separate from other services performed on the same day. This modifier is used when a provider performs a second service that is not typically reported with the first service. • Billing Example: A chiropractor provides a manual therapy service (97140) and a therapeutic exercise service (97110) during the same visit. The 59 modifier should be added to the second service (97110) to indicate that it was distinct from the first service. • Billing Tip: Only use the 59 modifier when the service is truly distinct or separate from other services provided on the same day. Overuse of this modifier can lead to billing errors and denials.

3. 10 Most Common Chiropractic Billing Modifiers • 2. Modifier XS • Description: The XS modifier is used to indicate that a service was provided in a separate anatomical site or organ system. This modifier is used when multiple services are provided on different areas of the body. • Billing Example: A chiropractor provides a spinal manipulation (98940) and a therapeutic exercise service (97110) during the same visit. The XS modifier should be added to the therapeutic exercise service (97110) to indicate that it was performed on a different anatomical site than the spinal manipulation (98940). • Billing Tip: Use the XS modifier when services are provided on different anatomical sites or organ systems. Be sure to document the specific sites or systems on the claim form. • 3. Modifier XE • Description: The XE modifier is used to indicate that a service was provided during a separate encounter. This modifier is used when multiple services are provided on different days. • Billing Example: A chiropractor provides a spinal manipulation (98940) on Monday and a therapeutic exercise service (97110) on Wednesday. The XE modifier should be added to the therapeutic exercise service (97110) to indicate that it was performed during a separate encounter. • Billing Tip: Use the XE modifier when services are provided on different days. Be sure to document the dates of service on the claim form.

4. 10 Most Common Chiropractic Billing Modifiers • 4. Modifier XU • Description: The XU modifier is used to indicate that a service does not have a specific, established code. This modifier is used when a service is provided that does not have a specific billing code. • Billing Example: A chiropractor provides a service that is not covered by a specific billing code. The XU modifier should be added to the claim form to indicate that the service does not have a specific, established code. • Billing Tip: Only use the XU modifier when there is not a specific billing code available for the service provided. Be sure to document the specific service on the claim form. • 5. Modifier XP • Description: The XP modifier is used to indicate that a service was provided by a physician assistant, nurse practitioner, or clinical nurse specialist. This modifier is used when the service is provided by a non-physician practitioner. • Billing Example: A chiropractor employs a physician assistant who provides a spinal manipulation (98940). The XP modifier should be added to the claim form to indicate that the service was provided by a non-physician practitioner. • Billing Tip: Only use the XP modifier when the service is provided by a non-physician practitioner. Be sure to document the specific practitioner on the claim form. • 6. Modifier AT • Description: The AT modifier is used to indicate that an active treatment was provided during the visit. This modifier is used when a therapeutic procedure is performed that requires the skills of a licensed therapist.

5. 10 Most Common Chiropractic Billing Modifiers • Billing Example: A chiropractor provides a manual therapy service (97140) that requires the skills of a licensed therapist. The AT modifier should be added to the claim form to indicate that active treatment was provided during the visit. • Billing Tip: Only use the AT modifier when an active therapeutic procedure is performed that requires the skills of a licensed therapist. Be sure to document the specific therapy provided on the claim form. • 7. Modifier GA • Description: The GA modifier is used to indicate that a service was provided, but is not covered by the patient’s insurance plan. This modifier is used when a service is provided that is not covered by the patient’s insurance plan, but is still necessary for the patient’s care. • Billing Example: A chiropractor provides a service that is not covered by the patient’s insurance plan, but is still necessary for the patient’s care. The GA modifier should be added to the claim form to indicate that the service was provided, but is not covered by insurance. • Billing Tip: Only use the GA modifier when a service is provided that is not covered by the patient’s insurance plan, but is still necessary for the patient’s care. Be sure to document the specific service provided on the claim form. • 8. Modifier GY • Description: The GY modifier is used to indicate that a service is statutorily excluded or does not meet medical necessity criteria. This modifier is used when a service is provided that is excluded or not medically necessary, but is still provided.

6. 10 Most Common Chiropractic Billing Modifiers • Billing Example: A chiropractor provides a service that is excluded or not medically necessary, but is still provided. The GY modifier should be added to the claim form to indicate that the service does not meet medical necessity criteria. • Billing Tip: Only use the GY modifier when a service is excluded or not medically necessary, but is still provided. Be sure to document the reason for providing the service on the claim form. • 9. Modifier GZ • Description: The GZ modifier is used to indicate that a service is expected to be denied as not reasonable or necessary. This modifier is used when a service is provided that is not expected to be covered by insurance. • Billing Example: A chiropractor provides a service that is not expected to be covered by insurance. The GZ modifier should be added to the claim form to indicate that the service is expected to be denied as not reasonable or necessary. • Billing Tip: Only use the GZ modifier when a service is not expected to be covered by insurance. Be sure to document the reason for providing the service on the claim form. • 10. Modifier 25 • Description: The 25 modifier is used to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as a procedure. This modifier is used when a significant E/M service is provided on the same day as a procedure.

7. 10 Most Common Chiropractic Billing Modifiers • Billing Example: A chiropractor provides a significant E/M service (99213) and a spinal manipulation (98940) during the same visit. The 25 modifier should be added to the E/M service (99213) to indicate that it was significant and separately identifiable from the procedure. • Billing Tip: Only use the 25 modifier when a significant, separately identifiable E/M service is provided on the same day as a procedure. Be sure to document the reason for the E/M service on the claim form. • Chiropractic billing modifiers provide additional information about the services provided to ensure proper billing and reimbursement. It is important to use these modifiers accurately and appropriately to avoid billing errors and denials. By understanding the descriptions and billing examples of these common chiropractic billing modifiers, chiropractors can improve their billing practices and optimize reimbursement for their services. • Legion Healthcare Solutions is a reliable chiropractic billing company that offers comprehensive billing services to chiropractors. We understand the complexities of chiropractic billing and are committed to providing personalized solutions that meet the specific needs of each client. Our team of billing specialists are knowledgeable about the latest coding regulations and can ensure that claims are processed promptly and accurately. By partnering with Legion Healthcare Solutions, chiropractors can focus on providing quality care to their patients, while leaving their billing needs in the hands of a trusted and reliable partner. To know more aboutour chiropractic billing services, contact us at 727-475-1834 or email us at info@legionhealthcaresolutions.com