How to Correctly Submit Chiropractic Diagnosis Codes to Medicare

By: Tom Necela, DC, CPC Click author's name for more of his/her articles

Billing chiropractic services for a Medicare patient can appear challenging because of the sheer volume) of rules that are specific to the chiropractic profession. In this article, we will concentrate on how to document diagnosis codes properly.
When considering chiropractic claims, since Medicare only pays for spinal manipulation for the correction of a subluxation, your claim needs a diagnosis of subluxation in the number one diagnosis position.
In reference to the HCFA claim form, this is Box 21D.
The only permitted primary diagnosis codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:
-- 739.0 Nonallopathic lesions of the head region not elsewhere classified
-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified
-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified
-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified
-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified
-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified
A word about terminology. Some doctors of chiropractic and coding books reference these diagnoses as segmental dysfunctions or subluxations or other such terms.
For example, 739.1 may be listed as cervical subluxation in some coding books. Regardless of what you label the diagnosis in reference to terminology, these codes mentioned above are the only primary codes that apply to chiropractic services in the Medicare program.
Caution.Using these codes does not automatically approve reimbursement however, due to the fact that the doctor's notes need to document that CMS coverage criteria

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About The Author: Tom Necela, DC, CPC of The Strategic Chiropractor teaches chiropractors to work smarter, not harder, with strategies for proper coding, billing, documentation and collections. His website is www.strategicdc.com .