Coding can be a tricky issue as there are a lot of different scenarios and complexities.
A question that a lot of chiropractors have is, “If you’ve scheduled a group therapy session, but some patients do not show up, causing the ratio of patients to providers to be one to one, is it still acceptable to code the session as group therapy?”
In this question you can see some of the complexities and confusion that can arise during coding. So here’s the clear and clean guidance you should follow. Always code with the code that most properly identifies the services performed.
If you were planning a group code with more than one patient, but you ended up treating only one patient, then using the group code for that single patient would not be appropriate. You would need to use the other timed code for that service.
This rule makes coding pretty simple and pretty straight forward. Just take each separate incident and always apply that rule. Always code with the code that most properly identifies the services performed and you’ll always be in great shape.
Another frequent question about coding is, “Can you down-code?” The answer is yes, you can down-code, but you should never up-code because when you up-code it looks like you’re trying to get paid more.
Down-coding simply means that you’re using a code that describes something that you would do less of. For instance, if you did a level 2 examination but you down-coded and only charged for a level 1 examination you’re ok.
It’s always ok to down-code even though you aren’t using the code that most properly identifies the service because there is no profit motive. You won’t have any problems using a code that pays you less, but you’ll always have a problem with a code that pays you more, which is up-coding.
You will have problems especially if the up-code does not properly identify the services that you performed on a patient.
To view this blog as a video click this link – Chiropractic Care – Billing Codes video.
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