I’ve heard different policies and coding requirements for the 98943 and a lot of inconsistent feedback from payers. How do I code my 98943 Chiropractic extraspinal adjustments for proper 3rd party payer reimbursement?
There has been a recent stir in the Chiropractic billing world recently regarding extraspinal billing! For several years, payers have been requiring a 51 modifier (or a 59 modifier for others) be used on the 98943 Chiropractic extraspinal adjustment when the service is performed in conjunction with a Chiropractic spinal adjustment (98940-98942).
The use of the 51 modifier for most payers will actually decrease the allowed reimbursement for the 98943, but the payers would not accept a spinal/extraspinal billing combination without it. The good news is that payers, including Optum Health payers, are starting to accept the 98943 service without the 51 modifier, even when billed in conjunction with a 98940, 98941, or 98942.
Our recommendation for coding the 98943 for optimal reimbursement is to first look at the diagnosis pointers associated with the service. Look to make sure that only extremity-related codes are being utilized for the 98943 and that no spinal-related codes are used. Also make sure that the diagnoses used are properly describing both the area being adjusted and the condition being treated.
Check with your Chiropractic billing service company or Chiropractic billing service software for updates on payers that are accepting the service without the 51 modifier and inquire about local payers you are billing for their modifier policy on the 98943 service.