Chiropractors all over the US have been seeing a recent increase in PI/WC denials related to the medical necessity of NMR services rendered on patients.
This is likely based on an industry-wide perceived overuse of the code and more stringent review of records for key data related to the relevancy of care to the injury.
While we don’t recommend discontinuation of the code altogether, we do recommend evaluating if the code is being used properly in your billing and reviewing how the service is being documented in your Chiropractic Electronic Health Records (EHR).
While reviewing your code selection for the patient, there is a key factor in determining if 97112 is the right therapeutic procedure code to choose – the indication.
The exercise being performed should be indicated to help re-educate the body part to perform a function/task that it was able to do in its pre-injury state. This exercise activity should be one-on-one with the provider and not in a group setting.
Does the code apply? If so, the next step is to make sure your documentation contains key components to communicate medical necessity. Here are our recommendations of what service-specific info to include in your EHr record:
- Document the service/code performed along with the time component
- Document the area of the body the service is being performed on as well as applicable diagnosis codes (this should be mirrored in your claim’s diagnosis order)
- Document the indications for treatment as well as treatment parameters, goals (include functional goals!), progress towards goals
- Document specific activities performed each DOS
Lastly, it is important that your billing gives you your best chance of reimbursement as well. Utilize diagnosis codes (from exam findings) that properly describe the functional deficits and if applicable, separate anatomical regions than adjusted that day.
Check with your Chiropractic billing software to ensure you are able to point separate diagnosis codes to different services to maximize your reimbursement on each service performed.
Even if the service was performed on a separate anatomical area than adjusted, be sure to use a 59 modifier on the NMR (97112) procedure to communicate this to the payer as well.
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