Billing and Coding: E & M Denial When Billed with CMT

Welcome to your billing and coding weekly solutions by H.J. Ross Company where getting your bills paid is what we do best!

Are you getting insurance denials for payment of Evaluation and Management (E&M) codes 99201-99215 when billed with chiropractic manipulation? You are not alone!

Here are 3 solutions to this insurance claim denial.

1. Modifier 25: Modifier 25 should be appended to the E & M code when billed with chiropractic treatment. The 25 indicates there was a separate and distinct evaluation above and beyond the pre- and post-evaluation associated with treatment.

2. Letter of Appeal: After coding the claim properly with the appropriate E & M code appended with modifier 25, your next step is to write a letter of appeal explaining the necessity of the separate examination.

3. Splitting claims: Split the claim using the same date of service with one claim for the E & M with modifier 25 and a second claim for the chiropractic treatment.

Billing with incorrect chiropractic CPT codes can lead to claim rejections and delays in payments, which can have a devastating impact on generating revenue and keeping you in business. 

If you are experiencing insurance claim denial, staff spending too much time trying to get claims paid, and patients asking why their claims have not been paid then H. J. Ross Company is your solution.

H.J Ross Company stays ahead of the curve on the latest trends and changes in billing and coding by utilizing their direct channel of communication with the insurance companies and organizations that set the guidelines.

There is a reason chiropractors have trusted H.J. Ross Company with their business for over 40 years.