|
|
|||||||||||||
|
April 2005 Changes EXPANSION OF COVERAGE FOR CHIROPRACTIC SERVICES DEMONSTRATION (MMA)
Provider Types AffectedChiropractors who practice in the States of Maine and New Mexico, Scott County, Iowa, 26 counties in Illinois (including Cook, DeKalb, DuPage, Grundy, Kane, Kendall, McHenry, Will, Boone, Bureau, Carroll, Henry, JoDaviess, Kankakee, Lake, LaSalle, Lee, Marshall, Mercer, Ogle, Putnam, Rock Island, Stark, Stephenson, Whiteside, and Winnebago counties), and 17 counties in central Virginia (including Pittsylvania, Campbell, Appomattox, Nelson, Buckingham, Fluvanna, Louisa, Caroline, Hanover, New Kent, Henrico, Richmond City, Danville City, Goochland, Cumberland, Powhatan, and Amelia counties). For more information : http://www.cms.hhs.gov/researchers/demos/eccs/default.asp
The Medicare
|
||||||||||||
|
97810: Acupuncture, one or more needles; without electrical
stimulation, initial 15 minutes of personal one-on-one contact with
the patient.
|
|
97811: Acupuncture, one or more needles; without electrical
stimulation, each additional 15 minutes of personal one-on-one contact
with the patient, with reinsertion of needle(s) (List separately in
addition to code for primary procedure).
|
|
97813: Acupuncture, one or more needles; with electrical
stimulation, initial 15 minutes of personal one-on-one contact with
the patient.
|
|
97814: Acupuncture, one or more needles; with electrical
stimulation, each additional 15 minutes of personal one-on-one contact
with the patient, with reinsertion of needle(s) (list separately in
addition to code for primary procedure).
|
Acupuncture is reported based on 15-minute
increments of personal (face-to-face) contact with the patient, not the
duration of acupuncture needle(s) placement.
If no electrical stimulation is used during a 15-minute increment, use
97810, 97811. If electrical stimulation of any needle is used during a
15-minute increment, use 97813, 97814
Evaluation and management services may be reported separately, using
modifier 25, if the patient's condition requires a significantly separately
identifiable E/M service, above and beyond the usual pre-service and
post-service work associated with acupuncture services. The time of the E/M
service is not included in the time of the acupuncture service.
Medicare Update October
Chiropractors have been submitting a very high rate of incorrect claims to Medicare. Medicare only pays for chiropractic services for active/corrective treatment (those using HCPCS codes 98940, 98941, or
98942). Claims for medically necessary services rendered on or after October 1, 2004, must contain the Acute Treatment (AT) modifier to reflect such services provided, or the claim will be denied.
GO – What You Need to Do
Make sure that your billing staff is aware that they must apply the AT modifier to HCPCS codes 98940, 98941, or 98942 when your clinical documentation reflects that the care you provided to a Medicare patient consists of active/corrective treatment. Additionally, your billing staff should be aware of any LCDs for these services in your area that might limit the frequency or circumstances under which active/corrective chiropractic can be paid.
The 2003 Improper Medicare FFS Payment report indicates that chiropractors have the highest
provider Compliance Error Rate in Medicare, filing claims incorrectly almost one-third of the time. Chapter 15, Section 30.5 of the Benefits Policy Manual states the Medicare program does not consider chiropractic maintenance therapy as medically reasonable or necessary, and is not payable under the Medicare program. So, in order for you to bill Medicare correctly, you need to indicate which of your claims are for active/corrective therapy and which are for maintenance therapy. A modifier (“AT”) already exists which can be used for this purpose.
Therefore, you must place an AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. For services rendered on or after October 1, 2004, all of your claims for active/corrective therapy (HCPCS codes 98940, 98941, 98942) that do not contain the AT modifier will be denied. This is because, as mentioned above, services without this modifier will be considered maintenance therapy (services that seek to prevent disease, promote health, and prolong and enhance the quality of life; or maintain or prevent deterioration of a chronic condition), and are not considered medically reasonable or necessary under Medicare.
However, the presence of the AT modifier may not, in all instances, indicate that the service is
reasonable and necessary. Carriers may develop LCDs that indicate an appropriate frequency of service. You may submit claims for services that exceed the frequency limits established within the LCD, with or without the AT modifier, depending on whether you believe that you have rendered active treatment or maintenance therapy, respectively.
In either case, your claims will be autodenied if the services exceed the frequency limits of reasonable and necessary services specified in the LCD. And, if contractors’ LCDs do not specify frequencies that define the limit of reasonable and necessary care, they may deny your claim, if appropriate, after medical review.
For those services that exceed the frequency limits established within the LCD, you may wish to obtain an Advance Beneficiary Notice (ABN) from the beneficiary and also apply the GA modifier (to be used when you want to indicate that you expect that Medicare will deny a service as not reasonable and necessary and that you do have on file an ABN signed by the beneficiary) or the GZ modifier (to be used when you want to indicate that you expect that Medicare will deny an item or service as not reasonable and necessary and that you have not had an ABN signed by the beneficiary), as appropriate