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.
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.