7 Most Common Modifiers in Chiropractic Billing

 

Modifiers are one of the most important parts of the medical billing process. Imagine you want to communicate a message in a language you don’t know. How difficult it is, right? The same is the case with chiropractic billing. They have their own language & if it is not used properly, the right message won’t be communicated.

The successful chiropractic coding and billing practices includes savvy practice management, healthy accounts receivables, a properly trained staff, and the ability to properly code and document diagnoses.

Modifiers in Chiropractic Billing
Modifiers in Chiropractic Billing

Why do you need to use Modifiers?

  • The modifiers help in recognizing the specific CPT codes, to keep them from being packaged into another service and charged on the same day.
  • It is reported along with the CPT codes, & tell the insurance companies that there is something unique about the services that are being billed.
  • It helps in increasing the reimbursements.
  • Claims can be rejected if the code that requires a modifier is billed without one.
  • It helps in understanding the payer’s specific recommendations.

 

Here are 7 most common modifiers that are used in Chiropractic Billing –

  • Modifier 25 – Evaluation & Management
    It is one of the most commonly used modifiers. It is an important, independently recognizable evaluation and management (E/M) service by the same physician on the same day. This modifier is only applicable to the E/M services.
  • Modifier 59 – Distinct procedure or services

It is one of the most important & separately recognizable non-E/M services by the same physician on the same day. The most common non-E/M service used by the chiropractors is Manual Therapy Treatment (97140). This code includes manipulation, & it should be modified with a 59 modifier if it is performed on the same day as an adjustment (CMT).

  • Modifier 26 – Professional component

This is added to the X-Ray codes to report the reading and written radiology report of x-ray view(s).

  • Modifier 52 – Reduced services

This code cannot be added to the CPT when reported with CMT on the same day, when the services are performed on the separate anatomical sites.

  • AT – Acute Treatment

This modifier is used to add to CMT for the medicare & medicare replacement plan claims that fall under the Medicare definition of Active Care.

  • TC – Technical Component

This modifier is used to add to X-Ray codes to report the taking of x-rays. For example, 72040 – TC, 72100 – TC, 72070 – TC.

  • X Set Modifier

XE Separate Encounter, XS Separate Structure, XP Separate Practitioner, & XU Unusual Non-Overlapping Service.

 

 

We at 24/7 MBS have a team of experts who have in depth knowledge of chiropractic billing and are having years of experience in using the modifiers. They know how to apply a correct modifier in a code that can help in increasing your reimbursements by understanding the payer’s specific suggestions.

Let us know what you need!

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