Dynamic Chiropractic

Dynamic Chiropractic Facebook Twitter Get the Latest News FASTER - View Digital Editions Now!
Dynamic Chiropractic
Advanced Search
Wellness Blog
Dynamic Chiropractic PracticeINSIGHTS
Current Graphic
Dynamic Chiropractic – January 1, 2006, Vol. 24, Issue 01
Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic

Examination Denials

By Samuel A. Collins

Q: I had a denial for examination (99204) of a new patient. On the EOB form, it stated that "the service billed is included in another procedure billed the same day." I do not understand this denial, as I am required to do an exam to ascertain the condition of my patient and formulate a treatment plan.

I did perform a chiropractic treatment in the same visit, but that code was for my specific manipulation service. Are they right - do I not get paid for an exam when I bill it with treatment? If not, what did I do wrong, and how can I get my examination paid?

A: You are correct in that you must perform an examination to determine the patient's condition and course of care. But, a common error when billing for an examination the same day as treatment is to not include the modifier -25 on the exam code (in this case, 99204-25). This modifier is certification that a significant, separately identifiable evaluation and management service (examination) was performed the same day.

The reason this modifier must be applied is that all chiropractic manipulative services have an included component that is a pre-service, intra-service and post-service assessment. This assessment is for the typical short history review and evaluation performed on each visit, prior to and after the day's treatment. This assessment is not billed separately (as the more extensive evaluation done on the first visit and on re-examinations would be). It is for this reason that an examination (evaluation and management code) is not to be billed on every visit.

To correct this claim, you must resubmit the billing with the proper modifier. It should then be paid. Including a copy of the examination with the rebilling is also useful, as it will avoid further delays should the insurance company want to view the record of the separate examination.

Samuel A. Collins
Santa Ana, California

Samuel A. Collins is an expert in chiropractic insurance billing for the H.J. Ross Network, a consulting group for doctors on billing and collection for insurance claims. His background is in the chiropractic profession, where he supervised a high-volume chiropractic clinic for 16 years. You are encouraged to submit billing questions to Mr. Collins at .

Click here for more information about Samuel A. Collins.

Dynamic Chiropractic

Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic
Dynamic Chiropractic
Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
Dynamic Chiropractic
How often do you reach out to patients who haven't visited your practice in six months or more?
Every few months
Every 3-4 months
Every six months or so
Once a year
Less frequently

Sign Up for Our Webinars
Receive Advanced Notice of Future Webinars