IT IS NO SECRET THAT Till- NUM-ber of post-payment audits from insurance companies is increasing by the month. In just the last month, I have talked with a number of chiropractors that have been forced to return between $80,000 and $300,000 in payments. I don't know about you, but that would set me back quite a bit. It is a reality that needs to be faced. Going cash does not solve the problem. If we go cash, we will lose our primary care physician status and we will be placed on the same level as a physical therapist. The best solution available to us is to equip ourselves with expert knowledge of proper coding and documentation—not your most exciting task but one that will let you sleep at night without the insurance company nightmare. As a professional coder, I have heard and seen about all there is in this area and I have dedicated myself to educating the medical community, especially the chiropractic sector, on the proper way to code and document. I often hear how the insurance companies have it out for chiropractic and that it does not matter what you do; you will be denied anyway. There is some truth to that but it is not an excuse for giving up. What you bill and document has as much effect on your patient as your adjustment docs. If you have ever lost a case for a Personal Injury patient because of poor documentation, you know what I am talking about. But there is no reason for this to happen. All of the laws pertaining to medical necessity and documentation are in your favor, if you just bother to inform yourself. There are a couple of things I recommend right from the start. You should purchase your code books every year. Doctors ask, "Do I really need a book every year?" Yes, you do. There are hundreds of changes every year in ICD, CPT and HCPCS. In 2006 alone, the ChiroCode Desk-Book excerpted 253 code changes for chiropractic from the big books. One missed code or concept could pay for keeping you current. Photocopy the CPT code book rather than writing denial response letters. We spend a great deal of time writing letters to prove our points; but, in the end, it is still our word against theirs. And you will almost always lose. So stop stating your opinion and start using the facts and the law. When you photo copy code book pages, you force the insurance companies to follow the same rules that you follow. SO, GET YOUR BOOKS!!! The ChiroCode DeskBook is all six books in one. It is easy to follow and there are a ton of ancillary products that come with it. Although useful, it is still just a resource, and it holds no real authority for some payers. So also get the AMA book, because it holds the power when you fight denials. If the payer denial is based on a code definition, this book will set the record straight. DH Leavitt from the ChiroCode Institute has arranged a special offer for offices that I send to the Institute. You can get both your annual AMA CPT code book and your ChiroCode DeskBook for only $149, with free shipping and handling. I want you to buy both. Call ChiroCode at (800) 873-9877 and ask for the ACOM Consulting Group Special. I receive no financial compensation on these purchases and that is why you get the deal you get. Once you have your books, you need to understand how they work, how CPT was created and its intended use. CPT establishes specific codes like Electrical Stimulation 97014 and Heat/Ice 97010. There is no room for question with these codes. If you do it, you bill it. They have also created codes that are general in their definition. See 97530 Therapeutic Activities: "dynamic activity to increase functional performance." So what constitutes "dynamic?" As a physician, you have probably heard many explanations about specific codes and coding in general from various sources. It is frustrating to figure out what is proper. Don't take my word or anyone else's. Stay with the books. If you cite printed literature by an authority in the field, you arc more likely to win the payment war. The key to CPT is that the majority of the codes chiropractors bill will be determined by their intent for doing a particular procedure. For example, if you bill 97110, therapeutic exercises, you typically have had your patient doing some type of rehabilitation activity, such as thera bands, stretches or walking on a treadmill. But, if you understand the code definition fully, you can see that it is open to far more things that can occur in your office. For example, the definition for the 97110 is "therapeutic exercises to develop strength and endurance, range of motion and flexibility. It does not specify how to do this; it just says the procedure must develop strength and endurance, range of motion and flexibility. You may not have a rehab area in your practice, but you probably do things in your practice with rehab as the intent. The key is to be on the same page with the AM A as they define things. When we understand our environment, we not only can exist in it, but flourish. On page 322 of CPT 2006 standard edition, first column, the AMA defines what a modality and therapeutic procedures are. You need to understand that, when you place a CPT code on your claim form, you are telling a story. Most chiropractic patient stories make no sense. The AMA defines a modality as "any physical agent applied to produce therapeutic changes to biologic tissue; includes but not limited to thermal, acoustic, light, mechanical or electric energy. " You should also understand that these therapies are designed for acute care, pain care. When you bill this throughout the entire care plan, you are not telling the most accurate story. For example, when you do your SOAP note, you probably ask how patients are doing on a scale of l-to-10, your typical Visual Analogue Scale. When you reach the point in care when they are telling you they arc at levcl-2, and you are still billing the modality codes, it makes no sense. If they are at a low pain level and you are still doing pain-orientated care, you encounter an issue of medical necessity. I hope this discussion has shed a little light on some of the issues you face in dealing with insurance companies. I don't deny that they make it difficult to get paid but, often, we are not helping ourselves either. So, I am calling the entire profession out—to stop playing the victim and start being proactive in your own behalf. I do not for one minute feel that the problem we are discussing here is your fault. Most of you lack adequate training in coding and documentation, so I am also calling out the schools, asking that they step up to the plate and put more emphasis on these vital areas. In doing so, I recognize that the mission of our institutions is to train doctors of chiropractic. But, let's face facts: If we don't code and document correctly, we have a bigger problem on our hands. Here is my challenge: If you are still reading this then you must feel that it is worth your time—and, if you feel that way, I want you to contact me and let me help you begin an adventure. Call your schools and ask them to provide coding and documentation education, not only to current students but, also, to you, as an alum. Let us work together. My commitment to you is two-fold: I) I will join with any school willing to make this a priority in their school, donating my time and knowledge for the good of the profession; 2) I will continue helping chiropractors in their private offices until God calls me to something different. I will end with this: Recently, I was on a panel where the question before us was how to help chiropractic grow in the coming years. I heard a number of the panelists say that we need more chiropractors contributing to state and national associations, that only one in five chiropractors belongs to a recognized association. 1 feel that this oversimplifies the situation. How can you give, when you can barely cover your overhead? To me, the solution is to equip doctors with the tools they need to flourish professionally, thus, creating both the means and the desire to give to others. I challenge all of my clients to give back to the profession when they have the ability to do so. Education and the knowledge // brings is the only thing that gives us that ability. That is my challenge and my call to arms. Who will join me? Bharon Hoag is the Senior Consultant in the ACOM Healthcare Business Consulting Group and Certified Professional Coder through the American Academy of Professional Coders. Previously he was founder and President of Hybrid Management. Inc. He has spent the last seven vears traveling across the United Stales teaching chiropractors proper coding and case management strategies. Visiting thousands of chiropractic offices gives him a strong grasp of the challenges facing the modern day chiropractic clinic. Bharon can be reached at 1-.S66-2N6-53I5, e.xt. 601 or at bhoagd6.acom.com
