The Illinois Chiropractic Society (ICS) has been working with the American Medical Association (AMA) in 2018 to clarify problematic language published in 2007 in the CPT® Assistant. The ICS noted that the 2007 guidance was overly inclusive in the number and types of services bundled as part of chiropractic manipulative treatment (CMT). We are happy to report that the AMA has recently revised this language to remove from the CMT narrative some of the elements that are more appropriately characterized as part of a patient re-evaluation.
The Illinois Chiropractic Society is continuing efforts to resolve with BCBSIL the problematic claims processing protocol implemented in November 2017. Many of our doctors continue to receive denials when billing services that require a billing modifier (primarily 25, 59, XS, and XU).
The Illinois Chiropractic Society has continued efforts to assist our doctors’ handling of the BlueCross BlueShield of Illinois (BCBSIL) claims processing protocol that began in November 2017. When applied, this BCBSIL claim edit, described by BCBSIL as “code-auditing enhancement” via “clinically validating modifiers,” automatically denies some providers’ claims on codes that require the modifiers 25 or 59 (including XE, XS, XP, XU). The issue is complex and presents difficult challenges for our doctors to be able to effectively examine and treat their patients.
Question: Dr. Kotlar, “My recordkeeping, coding, and collection systems are outdated. I’ve been documenting the same way for the last eight years even though I’ve added more services and products. I am seeing more patients but not collecting more money. Can you share some tips to help me improve?”