Chiropractic Claims Submission Tips

April 19, 2012

BCBSOK periodically conducts random prepayment and post payment audits. In a recent review of Chiropractic audits the following most common documentation and coding errors were noted:

  • Documentation that does not substantiate that all chiropractic manipulation procedure(s) reported were performed.
    • No documentation or insufficient documentation that all spinal levels of manipulation reported had been performed;
    • No documentation that each manipulation reported related to a relevant symptomatic spinal level. Documented symptoms must bear a direct relationship to the level of subluxation cited. Documentation of "pain" is not sufficient; the location of pain or condition must be described. Additionally, whether or not the vertebra listed is capable of producing pain or other conditions in that area should be documented in the chart.
  • Documentation that does not support level of Evaluation and Management (E&M) service billed.
    • The descriptors for the levels of E&M services recognize three Key components
      • History
      • Examination
      • Medical Decision Making
    • When selecting a level of service one must:
      • Identify the category or subcategory of service
      • Review the reporting instructions for the selected category or subcategory.
      • Determine the extent of history obtained.
      • Determine the extent of examination performed.
      • Determine the complexity of medical decision making.
      • Select the appropriate level of E&M service based on CPT® definitions and criteria.

For additional information regarding documentation and coding requirements please review CPT® guidelines.