lower back. Therefore, it would be appropriate. But if you were just to evaluate the neck again, that would not be part of it. Let's go back and think evaluation and management, did I show proper evaluation and management skills with this patient, did I document the levels properly? If I did do a larger level, was that level allowed? Was that level appropriate? Again, 99203 would probably be the highest level we'll do but if you have a patient with a significant lumbar disc or tingling down the leg, I would certainly say that's going to be part of it. Here's an example of a review that came in for a doctor. Notice here, in the very first paragraph it indicates, “The final discrepancy is related to your billings of Evaluations and Management CPT code 99213 with modifier 25 on the same day as Chiropractic Manipulation.” It notes our chiropractic consultant. Now, important to note, notice many insurance companies are using chiropractors. Our old argument used to be it wasn’t a chiropractic, most are using them, so this chiropractic consultant said review the medical records submitted by the office and determine the documentation, the treatment records does not substantiate the performance of a separately identifiable evaluation and management. I want to make sure that we're always thinking along the lines of whenever you have an exam, what was my reason for an exam? Was it 30 days? Was there a change in condition? Was there a significant change that caused the change in treatment plan? Always make sure for evaluation and management that you have some way of identifying that the exam was proper and the level that's billed. The next factor is just chiropractic and physical medicine. Obviously, chiropractic the most important thing we do make sure that the CMT code matches the diagnosis. Remember the style of your adjustment does not indicate the CMT code but rather the diagnosis. If you diagnosed three spine regions and are adjusting three spine regions you may use 98941. If you're only diagnosing cervical but you're manipulating several regions that's certainly acceptable to do, there's a lot of techniques that allow that, but you would still only bill a 98940 because you only have one region diagnosed. Again, chiropractic manipulation pretty straightforward, make sure your documentation also indicates the area you've adjusted and, of course, if it's Medicare make sure you're also identifying the specific spinal level. For physical medicine services and this is the area that they definitely will look a lot more closely at is they're going to look at the services you've
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