Modifiers in Chiropractic Medical Billing

1. Modifiers in Chiropractic Medical Billing Medical Billers and Coders

2. As per the recent study, it has been noticed that Blue Cross and Blue Shield (BCBS) given denials to chiropractic practices for the claims billed with modifiers. Companies that offer medical billing services identified that the majority of the claims were denied owing to the requirement of modifiers 25 and 59. According to the Explanation of Benefits (EOBs), the modifiers were utilized more than average or used improperly. In December 2017, the Illinois Chiropractic Society (ICS) announced that the cases they studied, the modifiers, and procedure codes were billed rightly as per the information of claims, but because of a code-editing feature introduced by BCBS claims were denied.

3. This incident has pointed to the importance of the usage of modifiers for Chiropractic Medical Billing. Proper utilization of modifiers can escalate reimbursement. If codes are billed without modifiers when it is required, the carrier will deny the claim with justification on the EOB of clubbing with another service. Normally, an Evaluation and Management service (E/M) is filed without a modifier. According to the American Medical Association (AMA), chiropractic manipulative treatment (CMT) (98940-98943) is a type of manual service to influence neurophysiological and joint function.

4. Modifiers in Chiropractic Medical Billing: • Modifier 25 • GA Modifier • GY Modifier • Modifier 59 • X-set Modifiers • The Active Treatment (AT) Modifier

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