When a chiropractor finds it necessary to adjust all 5 regions of a patients spine, he or she must be sure that the clinical documentation supports this code completely. 98942, 5 region chiropractic manipulation, is becoming a target for audits by Medicare and other payers. The reason for this is that payers have determined that many providers adjust all of the regions of the spine without documenting actual medical necessity for doing so. This makes for an easy denial and if documentation is not thorough, appeal may be impossible, and if this is frequently the case, an audit may be triggered.
When billing code 98942, be sure your documentation indicates a chief complaint by the patient stating they are experiencing pain or discomfort in, or injury to all five regions. Not only should a supporting chief complaint be documented, but clinical findings should also support the adjustment of all 5 regions, and a care planned should be outlined with subsequent clinical progress documented throughout continued care. Be sure to include diagnosis codes specific to each of the 5 regions in your documentation and on your claim. All of these factors should come together and provide support your billing, despite which code you choose to bill. Denials and audits happen, even if you are doing everything right. Don’t make yourself a target for auditing.
Protect yourself and your practice by being thorough and enjoy worry free patient care.