Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

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USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING https:// www.247medicalbillingservices.com Tel: + 1 -888-502-0537

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Recent statistical reports convey that the rate of claim denials from Blue Cross and Blue Shield is way high for chiropractic practices, particularly in the usage of modifiers. Many medical billing outsourcing companies that provide chiropractic practices realized that their claim denials are due to inappropriate use of the 25 and 59 modifiers. Either it was due to incorrect usage of modifiers or the utilization of modifiers was more than the required average.

Transcript of Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

Page 1: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING

https://www.247medicalbillingservices.com Tel: + 1 -888-502-0537

Page 2: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING

https://www.247medicalbillingservices.com Tel: + 1 -888-502-0537

Page 3: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING

Where do you use modifiers 25 and 59 in a claim form? The usual way of specifying Chiropractic modifiers in a claim form is they go along with CPT codes to convey the insurance company that a usual service type has not been billed. Using the right modifiers appropriately can bring down the denials rate and increase reimbursements. In case CPT codes are billed without adding modifiers, there are high chances that the insurer may reject the claim with a detailed explanation on the explanation of benefits (EOB) column with another service.Chiropractic manipulative treatment (CMT) and CPT codesCMT codes impose treatment for influencing joint and neurophysiological functions, which covers five spine regions indeed: cervical region, thoracic region, lumbar region, sacral region, and pelvic region.Let us look into the related CMT CPT codes now.For spinal 1&2 regions, the code is 98940For spinal 3&4 regions, the code is 98941For spinal 5 regions, the code is 98942For more than one extra spinal region, the code is 98943

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Page 4: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING

How to use modifiers 25 and 59 when submitting Chiropractic medical billing claims?Modifier 25 There are specific guidelines you may have to follow while reporting modifier 25 with CMT

codes. CMT codes have a pre-manipulative patient evaluation. In case you wish to specify additional evaluation and management (E/M) services, it should

be done individually using modifier 25. Note that this has to be provided only if the patient’s health condition needs it. Therefore if you are billing both manipulation and E/M codes for the same visit, modifier 25 should be attached by default to the E/M code.

Before submitting claims, providers should look for which category you are using modifier 25, i.e. whether it is commercial or federal.

Due to the E/M service can be caused by a similar type of conditions or symptoms, based on which the CMT services are provided there is no need of specifying it under different diagnoses.

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Page 5: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

USE MODIFIERS 25 AND 59 ACCURATELY IN CHIROPRACTIC MEDICAL BILLING

Modifier 59A new subset was released in the year 2015, by CMS, for the 59 modifiers, which are XE, XS, XP, and XU to be used in place of 59 modifiers wherever.Modifier XE can be used for a separate encounter when there is a distinct service and occurred during a particular meeting.Modifier XS can be used for a separate structure when there is a distinct service and performed on an individual organ or structure.Modifier XP can be used for a separate practitioner when there is a distinct service and performed by a different practitioner.Modifier XU can be used for an uncommon overlapping service when there is a specific service, and it does not overlap the standard components used in the main service.ConclusionUltimately, both modifiers 25 and 59 are critical to save your claims from denials and get quick reimbursements in Chiropractic medical billing services. Outsourcing Chiropractic medical billing and coding is the best and practical option to achieve optimized results and profits for your business. 24/7 Medical Billing Services is one such company that provides the necessary CMT billing and coding services with top-notch quality.

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Page 6: Use Modifiers 25 And 59 Accurately In Chiropractic Medical Billing

About 24/7 Medical Billing Services:

24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 42 specialties across the entire 50 states. You can rely on us for end-to-

end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%. Call us today at 888-502-0537 to know more on how we

can help boost profitability for your practice. 

Media Contact – 24/7 Medical Billing Services,

16192 Coastal Hwy, Lewes, DE – 19958

Tel: + 1 -888-502-0537Email - [email protected]

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