Blog, Chirosecure Live Event December 13, 2022

2023 – Coding updates and changes

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Everyone, welcome into another show with ChiroSecure. We’re always looking to make your practice a little bit better and what’s coming for 2023. This is Sam Collins, the coding and billing expert for chiropractic. And for you, let’s talk about 2023. What can we expect? What’s gonna change? What do we have to do differently?

Let’s find out. Let’s go to the. So we say here, what to expect in 2023? What to expect is always a little bit of updates, but more so the biggest factor is always update yourself. Change. Update in the sense of how are you gonna practice? Think of the new year, how are you gonna make your practice better?

What work last year, what didn’t work? And so forth. But let’s talk about it from the real analytics side. What’s going on with reimbursements and insurance and so forth. A lot of people often think that plan changes occur at first of the year, and most insurances do not. So don’t plan on or don’t expect any plan changes.

Certainly you can certainly verify a person’s insurance to see if there’s anything new, but very seldom does anyone have a plan that changes in January. Often it’s gonna be June or September. But certainly it’s worthwhile to check to make sure. Has there been any update? Not likely. What is going to change or of course not change but come back are deductibles.

So do be mindful. Deductibles will start January 1st, so we start that whole protocol again. And of course, remember once someone has a large deductible, that likely means a cast patient, but those that have ones that are lesser can be good. Obviously deductibles are something that are going to affect us, but keep in.

For patients who only saw the doctor in the last quarter. A lot of insurance companies have what they call a rollover deductible, and that’s worth looking into often. If the person has never been to any doctor within the year and just went sometime from October through December, often what they spent then will qualify for deductible for next year.

In other words, the person’s not being punished for getting sick at the end of the year. If you go to the doctor, December and then continued in January. A new deductible starts up. Most often that’s not going to be the case and we’ll roll over, but certainly worth checking. Now, of course, Medicare deductible always changes on January 1st, and this year I will happily say it went down a little bit.

It’s only $7 down, but nonetheless, it’s now 2 26, so Medicare deductible for next year will be 2 26. My little trick to this is don’t be so anxious to send out your claim right at the beginning of. . Most Medicare patients obviously go to a lot of medical doctors, let that medical doctor bill eat up that deductible.

Much easier for them than for us, and then therefore, the patient’s not having to come out of pocket to us. Certainly can be considered anyway, maybe within the first month. Don’t send the claim until February or so until it’s been met elsewhere. Now what we’ll also update of course, are gonna be fees and people often say our fee’s gonna update.

Unfortunately, Medicare fees do update often work comp fees do as well. But general health insurances as much as we would like them to do, they update on January. First, not often. And this year for relative value units, you’ll see very little change. There’ll be little adjustments, but nothing earth shattering.

In fact, what you’re gonna find for most of you for Medicare rates, they’re gonna have gone down a tiny bit, like a percent. Now a percent is not too bad, but it’s nonetheless not an increase. So you’re gonna expect probably. I’m gonna estimate between 50 cents and a dollar for each of your Medicare codes that are gonna be less this year.

And don’t forget, there’s the 2% sequestration that came back in. Still reasonable reimbursement for most areas for Medicare, about $40 for a 9 89 for one, give or take. But nonetheless, have you adjusted your fees recently? I want you to think back, and you can go back to one of the shows I’d done earlier this year.

Have you really adjusted fees and looked at the relative. Relative values often are not looked at well by chiropractors, and I generally will tell most offices you’re gonna have a handful of codes that you’re billing, maybe a few more than a handful, and of those, you’re gonna have half of those with an incorrect fee by example.

The fee for exercise and massage should actually be higher than 98, 9 40, because as a higher rv, This service therapeutic activities 9 7 5 30. So that type of exercise protocol, if you will, has a value of a 98 9 41. Neuromuscular education has a value about 20% above manipulation, so you want to be careful.

Often I find offices will have a code way below the expected rate, and of course, if you bill $30 for something and the plan is willing to pay 60, how much are they gonna pay you if you bill? $30 of course. So I would say take a look at your fees to see are my fees in line? Do they fit relative value units or am I way off?

Because certainly that’s something you should address each year because there may be some fees. You’re off a bit. I do that with my network members once a year. Please make sure you do the same. What’s going on with changes? Of course, with diagnosis? We went through this early this year cause it was October of this year.

But remember, ICD 10 always updates in October for the next. So the 2023 codes of course, began a few months ago, but nonetheless, let’s be mindful of what they were. If you didn’t watch the show. There’s some new codes for lumbar and lumbo sacral disc, specifically for a annulus fibrosis defect.

So a little bit different than the nucleus. A more specific code for each region, and again, it’s only for lumbar. Remember the one that says small is under four millimeters? Large is above four. This is probably gonna be found on an MRI or similar, but certainly a new code that you can have instead of just using the unspecified diagnosis.

What also changes are some new codes for muscle wasting. Of course, for the spine, we’ve always had codes for muscle wasting. These are just specific to the spine and you can imagine are there some spine issues that you often. Report but can’t because you would’ve to put there’s muscle weakness.

This is actually wasting. Think of someone that’s been a lot of disuse for an area that muscle wasting certainly be a pretty significant finding and part of the reason for rehab. So some new codes there, but what else is new? Okay, we know that okay, coding is updated a little bit. You should already be familiar with it.

The other thing that updated is concuss. , and I’m sure you’ve probably seen it, but there’s new concussion codes for unspecified amount of time because the concussion codes before were always a specified amount of time. Now it’s gonna be, I don’t know, I know I lost consciousness, but I don’t know, was it a minute?

Was it five minutes? So I think that’s a little bit more specific in the sense of not limiting it to a specific amount of time. I think most often though, are you gonna code, probably post-concussion syndrome? Are you doing concussion evaluations for people who’ve been in accidents? I hope. There’s also a new code for postviral fatigue syndrome.

That’s gonna be common post covid and so forth. Now, is that gonna be a primary musculoskeletal code? No, but it could be a complication of comorbidity. Even the dreaded as H and I say dreaded because so many people kind of lament about it, but they are looking for what information can you give them about the patient that needs them to prolong services?

And a person with fatigue would need longer care than someone. Now, it doesn’t mean you’re treating the fatigue, but you’re dealing with the effects of it. Don’t forget, complications and comorbidities do make a difference, particularly for plans where you have to deal with pre-authorizations. Think Primera a s h, optimum in several of these types of plans.

What’s going on for C P T this year? What’s changing there? Evaluation management, of course you’re familiar with did change a couple of years ago where now you can use. instead of just medical decision making, though both. So that’s something new for chiropractic. But there’s been an update to how we describe a new patient.

Now, this may not be as prominent in a chiropractic practice, but they did update a new patient, of course, is what? It’s always been brand new to your office or you haven’t seen them in three years, so that’s no different. But what is also updated though, is now it always said a different physician of a different specialty.

Now it’s more specific. So if you’re working in a multi-discipline, If a provider is not of the exact same specialty and subspecialty, even though they might two be the same, they can bill a new patient. So it’s not limited before. Oh, as a chiro or an AC or an Accu, or I shouldn’t say an Accu as much, but a chiro and or an MD that have subspecialties could build a new patient if you have a different specialty.

Now, probably not as specific for chiro, but at least nonetheless, a new change that’s there. Now, what has been affected though, that’s new for this year, 2023, is the consulta consultation codes 9 9 2 41 and 9 9 2 45 were eliminated. So now we just have the 2 42. Four three and four four. And they’re now described very similar to e and m codes, which are gonna be medical decision making, but also timed 20 minutes, 30 minutes, and 40.

But I wanna be careful, and I bring up these consultation codes because they’ve updated them. A lot of people go, oh yeah, cause I’m consulting my patient. Let’s remember, consultation codes are not for counseling. That’s an often misnomer. Consultation codes are actually for a second opinion. Of a patient you’re not treating someone has sent you for a second opinion and a report.

So again, not maybe typical in our offices, but for those of you who are doing independent exams, certainly this would be the case. But again, this includes the exam and the report. A little bit more expensive, of course, because the amount of work involved. But I wanna make sure you know that they did update a little bit, but it is not for counseling.

They’ve also eliminated in 2023, the prolonged service code 99 3, 54 and three fifty five, if you recall those. In, heck, if you’ve ever been to a seminar with me up to a few years ago, this was very prominent. This was the extra time code for an exam. That’s now no longer the case because now instead.

When you have extra time of an exam, you’re gonna use the code 9 9 417, and that’s for each additional 15 minutes beyond the time. So by example, if you have a 45 minute exam that goes to an hour, you would go from a 99 24 to a 2 0 5. But what happens if I go 15 minutes beyond the 2 0 5 time? That’s for this code comes in 9, 9, 4 7.

And remember, this time includes all the non-face-to-face things on the same day as an exam where this would be p. What if you have a patient that you received a lot of documents on them, reports, lab tests, whatever, and you review these on the day of the exam, that time counts towards the exam. And you would use the 9 9 417 for each additional 15 minutes above and beyond.

And that’s not to be confused with these two codes. 9, 9, 3, 5 8, and 3 5 9, and they’ve updated the terminology a bit, but in simplest term, these two codes are four. Record review extensive records, if you will. So it’s an evaluation of management, but record review. How many times have you gotten records from another doctor that you get a box or several inches?

You may bill for it for the time you spend. 9, 9 3 5 8 is for the first 30 minutes. and then after an hour, each additional 30 minutes is 9, 9 3, 5 9. I do want to implore, this is for extensive record review, but let me back up. Remember I said, what if you received those records the same day, or you do it the same day as an exam?

That record review actually counts towards the exam. So this is why 9, 9, 417 may be more prominent than you might think. It’s not just about the exam taking a long time, but all the data you make it. Think of a worker’s comp personal injury where these patients have had multiple providers, they’ve. Or you’re dealing with a long-term disability, that certainly could be the case.

And again, these codes are very well payable by all payers. There’s something new I won’t say new, but something I wanna start to engage a little bit this year, what’s called remote therapeutic monitoring. Now this is gonna require a very specific type of electronic health record system where you can do this monitoring, where patients can log in, but I think it’s well worth it because even the Medicare reimbursement for this is $166 and 25 cents per episode.

which means every 30 days. Now you might think where is this gonna fit on a personal or a chiropractic claim? I would say on a typical patient, maybe not, but what about a patient under long-term care with rehab, personal injury, where you’re trying to transition them to a home exercise program compared to one in the office where you’re gonna bill for this setup of.

the monitoring of it, and then depending on how much time you monitor, and it’s a minimum of 20 minutes a month, you get paid these amounts. Now I’m just introducing this because the first step would be for you to understand this is for something that has to be done electronically. The Zoom style, though you don’t have to do it zoom per se, it’s just gonna be interaction, but I think this is something that insurance companies have been looking for.

They want us to engage patients in more home exercise programs. This might be a place where you might start looking. Who is there a program I might do this with? I’m gonna suggest you take a look at the company web exercises as they have a protocol for, but there’s a few others, but I think theirs by far is the best one.

So take a look. It’s web, but it’s starting to think of not just because there’s reimbursement, but how am I gonna help my patient? You’ve all seen this. You prescribe a home exercise program for a. . They don’t do it. It doesn’t work. And now all of a sudden your care plan has shown that it’s not effective.

It wasn’t effective because it wasn’t a good follow through. This will force the follow through cause it monitors the patients as they log in to perform. What about chiropractic and physical medicine? What’s gone on here? There’s no updates to chiropractic codes. Those remain the same, but do be conscientious if you’re billing a 98 9 41.

how many regions must you diagnose minimally? At least three up to four. So please make sure that you’ve diagnosed properly before using. And let’s remember the values. A 99 41 should be about a third higher than your four oh and so on. 98. 9 43 is literally just 2% below. So make sure your fees make sense.

Now, what about physical medicine codes? Nothing new updated there. I do wanna highlight though, of course the VA is covering. . So I do wanna highlight the VA is covering laser. A few others might, but are there any new codes there? No, but what I’m gonna emphasize to you all is the proper documentation of such we’ve run into problems where services are not documented well.

I work a lot with ChiroSecure, and as many of you’re aware, ChiroSecure offers a very robust coverage because it covers you for audits. So what do you do if all of a sudden insurance company is sending you something saying, Hey, this wasn’t properly documented. Who’s gonna defend? . That’s what ChiroSecure does.

Please make sure your policy is up to date. And if you’re not with ChiroSecure, I’m gonna recommend it because who’s gonna protect you? They’re gonna hire experts and attorneys to defend you, but you have to make sure why? Why are we defending? Because often the documentation doesn’t match. I wanna make a real simple rule.

Make sure that everything that you’ve provided is documented and documented in such a way that if someone were to read it, they can see how it was done. If you indicated I did ultrasound to the. That actually wouldn’t be adequate. You would want to indicate I did ultrasound to the left patellar tendon, five and eight minutes.

That’s very specific. So please make sure everything’s documented. I do wanna emphasize time. As many are aware. I’m on the Optum Health UnitedHealthcare Coding and Reimbursement Committee, and one of the things they emphasize that chiropractors do very poorly is document time. So please emphasize time when it’s a time service.

I’m also gonna say for documentation, this is not new. Please make sure you have proper outcomes if you’re not already. Please make sure you have a good validated outcome assessment that you’re doing at the initial visit, and then probably every two weeks I’m gonna recommend like a general pain index, pain interference.

Oswestry and all those are good, but sometimes patients have difficulty filling ’em out over periods of time, so have something simpler but still functional. Let’s remember chiropractic works. But can I see it in your notes? Even if your documentation is slightly below average, but you have a good outcome, that mostly will save you from many types of audits or other issues.

And the other area I want to emphasize for 2023, and I’ve seen this a lot cuz I’ve dealt with this and of course this is also something ChiroSecure protects you with. What if an insurance is coming back saying, Hey, we wanna see the information of how you collect. From the patient, and we’ve seen quite a bit of this with UnitedHealthcare as well as Cigna this year, actually this last quarter, where they’re sending patients information and to you wanting to know who paid the copays, the co-insurance and deductibles, and are looking for any type of receipts or payments.

So please make sure that patients are paying their copays and deductibles. Be careful if you waive a deductible. It’s a kick. Now absent a hardship here or there, remember waving fees is considered a kickback. It’s also just bad business. If you’re not collecting a $20 copay per patient and you’re seeing a hundred visits a week, my goodness, you’re losing probably about a hundred thousand dollars a year just off of that.

So get in the habit. Your services are valuable. And if a patient has some issues, have them pay over time. But be very careful of just simply waving. And we’ve run into a few offices because patient’s deductibles are so high, they’ve just waived it. Maybe that type of patient you might wanna put on your cash plan, put on your prepaid plan because they may not meet the deductible.

And don’t put yourself in trouble and help them. Help them in another way. Please bear in mind, your practice is yours, you. , you set the parameters and while I want everyone to have a very successful practice, I hope it’s diversified, so that when economy is changing or perception of such, you always have a place to fall back.

As you have many irons in the fire. Are there some good insurance plans? You bet there are. Are there some really awful ones? You bet there are. Remember, you can always cherry pick. , because you Bill one doesn’t mean you have to bill them all. Don’t be afraid to accept certain ones. The only one that’s an issue is Medicare.

Remember, as a chiropractor, you do have to belong to Medicare, whether par or non-par. To in order to see Medicare patients. And remember, if you wanna make a change, we’re still early December. You’ve gotta do it now. If you want to change your status with Medicare, please do it before December 31st. If you do not, you can’t change it during the regular part of the year.

It’s gotta be only in the last quarter during the enrollment period. There’s a lot of new things and exciting. We have lots of seminars coming up. You’ll see here the things we’re covering, the locations. Take a look at our website, HJ Ross Company. We are the definitive source of coding, billing, documentation, and frankly, reimbursement.

Our seminars are not boring. We actually offer a service too, where we can work with you one-on-one, where I become part of your office, get an. Get your claims paid. I wish you all the best. I wish you a good new year, and thank you very much. I’ll see you next time. Everyone see you in 2023. Good luck and best wishes.