As a holistic therapy for multiple musculoskeletal health conditions, the need for chiropractic services has grown over the decades. Chiropractors utilize various techniques to enhance functions and improve patients’ mobility. In addition, there exist specific codes and billing guidelines for chiropractors in the United States. Chiropractic medical billing is relatively new, and you don’t have to look far back to find out when medical insurers denied reimbursement for chiropractic services. 

However, to ensure your services are reimbursed accordingly, your billing must be completed correctly and within compliance guidelines. Perhaps one of the challenges chiropractors face is working within strict limitations of the insured’s coverage restrictions. Therefore, holistic billing demands effective and correct coding of the care provided. Nonetheless, as the year ends, it’s time to enhance your chiropractic practice to increase efficiency and improve revenues. One way to do this is to adhere to the chiropractic billing updates and review your practice management software. Here are chiropractic billing updates for 2023. 

New 2023 CPT Codes

The American Medical Association (AMA) released CPT Evaluation and Management (E/M) Code and guidelines effective January 2023. 

Ranging from the revisions made to the E/M codes for office visits care in 2021, the 2023 modification focus on making coding and documentation flexible for other E/M care services, allowing physicians and care teams to save time providing quality care rather than spending a lot of time on irrelevant administration services. The 2023 updated modification to the E/M codes creates more time for inpatient and observation services, emergency department services, consultation, and nursing facility services. 

Hence, the coding process in nearly all E/M services has been simplified and made more flexible for the chiropractic billing team.

Changes to the E/M codes are among the 393 editorial edits made to the 2023 CPT code set, including 75 deletions, 225 new additions, and 93 revisions. With 10,969 codes describing medical procedures and services available, the CPT code is attributed to evolve and expand rapidly due to innovations in health technology and medical science.

The CPT codes 98940-98943 are essential in chiropractic services. In this regard, your billing team must consider the following:

  • Report the initial treatment procedure
  • Report the date of the X-ray if it was applied, including the X-ray film
  • If an X-ray is unavailable, a physician’s examination may be used to document subluxation. The physical examination record must reflect the subluxation.
  • Report subluxation using the recommended ICD-10-CM code
  • All treatment procedures should be categorized as maintenance therapy, chronic subluxation, or acute subluxation

Your organization will need to use the codes 98940, 98941, and 98942 in reporting the specific manual treatment applied to affect neurophysiological functions and joints. 

Skilled, Reasonable, and Necessary Care

Going forward, you’ll be required to bill only for direct services provided to patients. Services must only be billed if they need direct observation by a therapist or care provider licensed to provide specified care. Therapy services entailing direct patient (97032-97039, 97530-97546, and 97110-97150) contact should be billed if only provided by an occupational or physical therapist or an assistant, or any other individual licensed to perform such tasks. However, services offered by aides, technicians, chiropractic assistants, exercise physiologists, or any other non-licensed care provider should not be billed. 

Care provided by the patient or unskilled assistant or technician in the clinic without the supervision of a licensed care provider is not recognized as professional therapy, hence shouldn’t be billed. 

In 2023, chiropractic services will only be billed if they are reasonable and medically needed. Therefore, all services provided must align with the patient’s condition based on the duration and frequency of intervention. 

Direct Patient-Chiropractor Contact

CPT codes 97032-97039, 97530-97546, and 97110-97150 entail direct physician-patient contact. As a result, the time billed is based on direct one-on-one contact between the patient and care provider. The patient’s insurer will look at the exact time spent providing care based on the patient’s clinical needs. However, the time patients spend waiting for equipment or resting in your clinical facility does not include the treatment period. In addition, supervision of patients who exercise independently is not part of direct contact care, hence shouldn’t be billed.

Billing Software 

Not all billing software is made the same. In addition, the benefits and features of each software vary across practices. An evolution in billing software sees a significant improvement to enhance best practices in your clinic. An evolved chiropractic billing software includes the following features:

Integrate billing with EHR and Practice Management

An EHR is critical in modern record-keeping in any healthcare setting. Cloud-based EHR and billing system allows remote data access. This allows efficient tracking of scheduling and appointments and effective and correct billing. 

Integrated billing software for 2023 will give your team easy access to payment information, appointment date, and patient health record from a single platform. 

Flexible Payment Options

Dealing with insurance companies in chiropractic practice can be a headache due to the complex nature of services. However, the 2023 billing software is built for flexibility and efficiency. The software will enable your clients to include their information during clinical visits, making updating and filing claims easier.

Manual and Massage Therapy in Chiropractic Care

Therapeutic procedures are essential in relaxing or preparing a patient for manipulation. They are included in the manipulation reimbursement when performed at the same clinic on the same day. When you conduct manual therapy on the part of the body unrelated to patients’ manipulation, the service can be reimbursed separately. However, for the reimbursement to be considered separate, you must meet the following conditions:

  • Manipulation must be performed on the same part of the body on the same day
  • The care provided must be skilled, specific, and necessary

For successful reimbursement, you’ll need to document the following:

  • The duration of treatment from start to end
  • Clinical rationale for separate treatment
  • Critical description of the part of the patient’s body treated and rationale.

Get Chiropractic Software for Efficient Claim Processing

To adhere to the 2023 chiropractic billing updates, you need effective billing software. Apex EDI provides solutions to help organizations streamline their billing process. Apex EDI integrates effectively with your current practice management or EHR system, saving you the cost of switching. Our professionals allow you to focus on providing care while we take care of your billing, saving you time and resources. In addition to claims processing, we provide an array of services nationwide including verifying patient eligibility for benefits, settling and organizing patients’ statements, and preparing custom summary reports. Contact Apex EDI today to prepare your chiropractic practice for a successful 2023.